AK-Inpatient Care Coordinator, Days(40 hours GTD), **Case Management Certification from NCQA or CCMA Preferred** - Sitka

Mobile Health Team Inc, is a Nurse owned staffing agency that focuses on meeting the needs of our healthcare professionals by offering a variety of placement options, flexible scheduling and competitive pay.

We are currently looking for experienced, hardworking and compassionate Healthcare Professionals to join us and help bridge the staffing gap in all aspects of the healthcare system. We offer PRN, Contract and permanent positions.

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: 9/5/2024

13 weeks | Varied | 8-to-12-Hour shift | 40 hours per week guaranteed

The Estimated Weekly Total is based on working the listed number of hours per week and includes available stipend amounts. Please contact a recruiter for full details.

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 select 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 leadership, clinical care team, and physicians to ensure healthcare services are appropriate and cost-effective.
• Collaborates with physicians, 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 the organization by providing quality reviews.
• Performs tumor registry functions for the organization.
• Other duties as assigned.
  
  

Experience/Education/Qualification

Experience:

• Must have at least 8 years of clinical care or nursing experience; at least 3 years of which should be in chart review, risk management, or related quality service.
  
  

Education

• Must have a high school diploma or equivalent.
• Bachelor’s Degree in Nursing is preferred
  
  

Licenses, Certifications, And/or Registration

• Case Management certification from a recognized certifying organization (i.e., NCQA, CCMA) is preferred; can be obtained within 24 months of hire.
• Must have an active nursing license in Alaska or another U.S. state.
  
  

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.
• Agency staff must have an active Alaska license.
  
  

M-276535

Mobile Health Team, Inc is 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.