RN - Patient Care Coordinator

Mt. Edgecumbe Medical Center•Sitka, AK

2d•Onsite

About The Position

Manages patient progression of care, promotes evidenced-based protocols, ensures the appropriateness of interventions, and expedites care delivery for patients admitted. Directs patient care services to ensure a timely and appropriate patient discharge.

Requirements

Bachelor's Degree in Nursing required.
Active nursing license in Alaska required.
8 years of clinical care or nursing experience, with 3 years in chart review, risk management, or related quality service.
Knowledge of ICD-9 and CPT coding, and CMS regulations.
Strong written, oral communication, and organizational skills.
Ability to communicate and collaborate effectively.

Responsibilities

Reviews patients' records and evaluates patient progress.
Performs continuing review of the patient hospitalization to monitor necessity and appropriateness.
Provides review functions for the Purchased/Referred Care Services program for SEARHC beneficiary patients.
Obtains and reviews medical reports and treatment plans as requested.
Reviews and validates physician orders, reports progress and unusual occurrences.
Collaborates with MEH leadership, clinical care team, and physicians to ensure healthcare services are cost-effective.
Reviews new hospital admissions to develop personalized treatment plans.
Provides required information to patients and/or their families regarding healthcare benefits.
Ensures maintenance of the Utilization Review Plan in collaboration with the Utilization Review staff.
Facilitates educational programs and advises physicians on regulations affecting UM/CM/DCP.
Directs coordination of patient care departments based on patient needs.
Communicates with payers within required timeframes.
Prepares information for notification letters, processes requests for appeal of denials, and maintains review logs.
Performs tumor registry functions for SEARHC and supports clinical improvements.