RN - Care Coordinator - In-patient - Utilization Review

SouthEast Alaska Regional Health Consortium (SEARHC)•Sitka, AK

2d•$42 - $59

About The Position

As part of a consortium-wide team, support and manage patient progression of care in the hospital setting, promote evidence-based protocols, ensure the appropriateness of interventions, assess patient psycho-social needs, and expedite care delivery for patients. SEARHC is a non-profit health consortium which serves the health interests of the residents of Southeast Alaska. We see our employees as our strongest assets. It is our priority to further their development and our organization by aiding in their professional advancement. Working at SEARHC is more than a job, it’s a fulfilling career. We offer generous benefits, including retirement, paid time off, paid parental leave, health insurance, dental, and vision benefits, life insurance and long and short-term disability, and more.

Requirements

Current full, unrestricted Registered Nursing license in Alaska or other U.S. state required. Bachelor’s preferred. Direct Hire must have applied for an Alaska nursing license before start date. Agency staff must have an active Alaska license.
Case Management certification by recognized certifying organization within 24 months of hire.
BLS.
ACLS.
PALS preferred.
High school diploma or equivalent required.
Clinical Competency required within 3 months of hire and every three years
High Risk Competency required within 3 months of hire and every year
5 years clinical nursing experience
1 year experience with chart review, risk management, or related quality service preferred.
Knowledge of Medical record review, medical necessity/insurance guidelines, and regulatory compliance.
Skills in Communication, both verbal and written
Strong organizational skills
Ability to Work collaboratively as part of an interdisciplinary team.
Build relationships with colleagues, community partners, and consumers.

Nice To Haves

Bachelor’s preferred.
PALS preferred.
1 year experience with chart review, risk management, or related quality service preferred.

Responsibilities

Works collaboratively with consortium wide team supporting inpatient Care Coordination and Utilization Management
Coordinate local CAH Swing Bed/Transitional Care program.
Lead local CAH Inpatient interdisciplinary team meeting.
Reviews all admissions to develop personalized treatment plans that are clinically appropriate, match the patients care needs and are consistent with patient choice and available resources while ensuring a timely and appropriate discharge.
Collaborate with providers, leadership, and clinical support team to ensure treatment plan is based upon patient need and meets criteria approved by consortium and regulatory agencies/payors.
Ensure ongoing documentation supports Utilization Management functions and communicate with payors appropriately.
Provide appropriate information to educate patients/families regarding healthcare benefits and treatment plan.
Assess patient to obtain relevant psycho-social information, make interventions and professional support referrals as needed.
Develop and communicate discharge plan with the care team and patient/family, ensuring safe and well-coordinated transition of care.
Support Peer Review process as part of consortium plan.