Responsible to manage the patients’ progression of care, promote evidenced based protocols, assure the appropriateness of interventions and expedite care delivery for patients’ admitted to Mt. Edgecumbe Hospital. Directs patient care services to assure a timely and appropriate patients discharge. Performs utilization review and inpatient case management at Mt. Edgecumbe Hospital in accordance with all state and federally mandated regulations.
Under general supervision, provides professional assessment, planning, coordination, and implementation, of the functions for Coordination of Care (CC) and Utilization and Management (UM). Oversees collection and reporting of data to support the CC and UM programs and the operations of Mt. Edgecumbe Hospital. This position maintains compliance with regulations affecting utilization management and continuum of care. The job functions directly impact the revenue cycle. The position will work collaboratively with the nursing leadership team, the patients care team, and physicians to develop, implement and evaluate individualized patient treatment plans and ensure that patients receive medically appropriate services. Responsible for promoting quality care that encourages appropriate use of available resource during all phases and location of care.
Education and Experience:
Bachelor’s Degree in Nursing and eight (8) years clinical care or nursing experience, 3 of which would be in chart review, risk management or related quality service.
Case Management certification by recognized certifying organization (i.e., NCQA, CCMC) preferred can obtain within 24 months of hire
Knowledge, Skills & Abilities:
Advanced knowledge in conducting and reviewing medical record for medical necessity, level of care, and public and private insurance reimbursement.
Working knowledge of basic ICD-9 and CPT coding.
Working knowledge of regulations as set forth by The Centers for Medicare Medicaid Services.
Proficient in medical terminology, anatomy, physiology, and concepts of disease.
Skill in providing effective nursing care, assessing patient situations and taking effective courses of action.
Skill in operating a personal computer utilizing a variety of software applications.
Strong written and oral communication skills.
Strong organizational skills.
Ability to communicate and collaborate effectively with providers, staff, and patients.
Internal Number: 2020-4331
About SouthEast Alaska Regional Health Consortium (SEARHC)
SEARHC is a non-profit health consortium which serves the health interests of the residents of Southeast Alaska.
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