Ak - Inpatient Care Coordinator/Manager, Varied(Days/Evenings) - Sitka

Mobile Health Team Inc., a staffing agency has openings for an Inpatient Care Coordinator/Manager. We are looking for someone with a passion for people.

Location: Sitka, AK 99835

Assignment Start Date: 12/28/2023

13 weeks |Varied | 8-10-hour shift | 40 hours/weekly guaranteed

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.

ACCOUNTABILITIES

• Review patients' records and evaluate patient progress.
• Performs continuing review of the patient hospitalization to specifically monitor the necessity for and appropriateness of hospitalization, length of stay, and quality of care.
• Provides these UM and review functions to the Purchased/Referred Care Services program for SEARHC beneficiary patients admitted to other facilities.
• Obtains and reviews necessary medical reports and treatment plans as requested by regulatory agencies or payers.
• Reviews and validates physician orders, and reports progress and unusual occurrences on patients.
• Works with the MEH leadership, clinical care team, and physicians to ensure healthcare services are appropriate and cost-effective.
• Collaborates with physicians, MEH leadership, and the clinical care team to ensure adherence to the UM/CM/DCP plan.
• Reviews new hospital admissions to assess patient condition(s) and needs to develop personalized treatment plans.
• Provides appropriate or required information to patients and/or their families regarding their healthcare benefits.
• Review patient records and participate in interdisciplinary collaboration with professional staff.
• Ensures maintenance of the Utilization Review Plan collaboration with the Utilization Review staff Medical Director (or designated provider).
• Facilitates educational programs and advises physicians and other departments of regulations affecting UM/CM/DCP.
• Directs the coordination of patient care departments, ensuring treatment plans are based on the needs of the patient and meet criteria approved by the hospital and any regulatory or payer requirements.
• Ensures documentation supports the UM functions and communicates with payers within required timeframes.
• Reviews information, communicates results to claims adjusters and enters billing information appropriately.
• Prepares information for notification letters to providers, staff, and patients.
• Received and processed request for appeal of denials.
• Respond to complaints per UM review guidelines.
• Maintains utilization review and appeal logs.
• Supports clinical improvement activities of SEARHC by providing quality reviews.
• Performs tumor registry functions for SEARHC.
• Other duties as assigned.

EXPERIENCE/EDUCATION/QUALIFICATION

Experience:

• 8 years' clinical care or nursing experience, 3 years of which should be in chart review, risk management, or related quality service

Education: High school diploma or equivalent required.Bachelor's Degree in Nursing

Licenses, Certifications, and/or Registration:

• Case Management certification by a recognized certifying organization (i.e., NCQA, CCMC) can be obtained within 24 months of hire.
• An active nursing license in Alaska or another U.S. state is required. (Agency staff must have an active Alaska license.)

EMR System: Cerner experience/knowledge preferred.

Shift: Will discuss this at the interview.

Vaccinations:MUST HAVE ALL COVID-19 VACCINES (INCLUDING 1 BOOSTER) AND FLU VACCINES

Knowledge/Abilities/Skills:

• Conducting and reviewing medical records for medical necessity, level of care, and public and private insurance reimbursement.
• Basic ICD-9 and CPT coding.
• Regulations as set forth by The Centers for Medicare and Medicaid Services.
• Proficient in medical terminology, anatomy, physiology, and concepts of disease
• Providing effective nursing care, assessing patient situations, and taking effective courses of action.
• Strong written and oral communication skills.
• Strong organizational skills.
• Ability to communicate and collaborate effectively with providers, staff, and patients.

Mobile Health Team, Incis a workforce solutions company. We match experienced healthcare professionals with temporary or permanent positions globally.

Our mission is clear, to bridge the staffing gap in the healthcare industry by creating and maintaining long-term working relationships with clients and healthcare professionals. We specialize in temporary and permanent placements in order to meet our client's needs.