Case Manager

*Job Title:* RN Inpatient Care Coordinator / Utilization Management *Job Type:* Contract *Contract Duration:* 13 Weeks *Start Date:* October 5, 2026 *Schedule:* Day Shift *Specialty:* Nursing – Care Management The pay rate for a local candidate is *$10 less than the rate offered to a travel candidate* Position Overview We are seeking an experienced *Registered Nurse (RN) Inpatient Care Coordinator* to manage patient progression of care, utilization review, care coordination, and discharge planning. The ideal candidate will have extensive clinical nursing experience with strong expertise in *chart review, utilization management, risk management, quality services, and inpatient care coordination*. This role works closely with physicians, clinical leadership, patients, families, payers, and multidisciplinary teams to ensure appropriate, timely, and cost-effective care. Key Responsibilities * Manage and monitor the progression of care for hospitalized patients. * Review patient medical records and evaluate clinical progress. * Conduct ongoing utilization review to assess *medical necessity, level of care, length of stay, and quality of care*. * Review new hospital admissions and assess patient conditions and care needs. * Develop and support individualized treatment and discharge plans. * Review and validate physician orders, treatment plans, reports, and clinical documentation. * Collaborate with physicians, hospital leadership, and multidisciplinary clinical teams. * Ensure patient care meets hospital, regulatory, and payer requirements. * Communicate with insurance companies and payers within required timeframes. * Review medical records and obtain required reports for regulatory agencies and payers. * Provide patients and families with information regarding healthcare benefits when appropriate. * Maintain accurate Utilization Management, Care Management, Discharge Planning, and appeal documentation. * Process requests for appeals and respond to complaints according to established guidelines. * Maintain utilization review and appeal logs. * Support quality improvement initiatives through clinical and utilization reviews. * Assist with Purchased/Referred Care Services patients receiving care at outside facilities. * Provide education and guidance to physicians and departments regarding utilization management regulations. * Prepare notification letters and required information for providers, staff, and patients. * Perform tumor registry functions as assigned. * Perform other duties as assigned. Required Qualifications * *Bachelor’s Degree in Nursing (BSN)* required. * *Active Alaska RN license is mandatory at the time of submission.* * Agency/travel candidates must have an *active Alaska nursing license*. * Minimum *8 years of clinical care or nursing experience*. * At least *3 years of experience in chart review, risk management, utilization management, or related quality services*. * Strong knowledge of medical terminology, anatomy, physiology, and disease processes. * Knowledge of medical necessity and level-of-care review. * Knowledge of public and private insurance reimbursement requirements. * Understanding of *CMS (Centers for Medicare & Medicaid Services)* regulations. * Basic knowledge of *ICD-9 and CPT coding*. * Strong written and verbal communication skills. * Excellent organizational and analytical skills. Preferred Qualifications * *Case Management certification* from a recognized organization such as *CCM/CCMC or NCQA* preferred. * Previous experience in *Utilization Review (UR), Utilization Management (UM), Case Management, Discharge Planning, or Care Coordination* preferred. * Experience working with hospital-based multidisciplinary teams preferred. Compliance Requirements * *Active Alaska RN license required at submission.* * *Flu vaccination required.* * Fingerprint cards are required for background clearance. * After acceptance, the traveler must schedule fingerprinting and mail the fingerprint cards to *SEARHC in Juneau within 2–3 days*. * The start date will be *no less than 6 weeks after SEARHC receives the fingerprint cards* for processing. * Delays in submitting fingerprints may result in the start date being pushed back. Pay: $84.00 - $88.00 per hour Education: * Bachelor's (Required) Experience: * clinical care or nursing experience.: 8 years (Required) * chart review, risk management, utilization management: 3 years (Required) * hospital-based multidisciplinary teams : 2 years (Preferred) License/Certification: * Active Alaska RN license (Required) * Case Management certification (Preferred) Work Location: In person