RN Inpatient Care Coordinator

Job Description

Job Description

Job Summary

We are seeking an experienced RN Inpatient Care Coordinator for a 13-week travel assignment in Sitka, Alaska.

This is a senior-level care coordination and utilization management position requiring extensive clinical nursing experience combined with a strong background in medical record review, medical necessity, level-of-care determination, reimbursement, risk management, and healthcare quality .

The RN Inpatient Care Coordinator will work closely with physicians, nursing teams, case management, utilization review, payers, and other healthcare professionals to promote appropriate resource utilization, support timely patient care, and ensure documentation meets clinical and reimbursement requirements.

Candidates must have an active Alaska RN license , a Bachelor of Science in Nursing, and at least 8 years of clinical nursing or patient-care experience , including a minimum of 3 years in chart review, risk management, utilization management, or a related quality-focused role .

Key Responsibilities

· Review inpatient medical records for medical necessity and appropriate level of care.

· Evaluate patient status and documentation to support appropriate admission and continued-stay decisions.

· Conduct concurrent and retrospective medical record reviews as required.

· Assess clinical documentation for completeness and alignment with reimbursement requirements.

· Support utilization management and appropriate use of hospital resources.

· Collaborate with physicians and clinical staff to clarify documentation and care requirements.

· Identify potential barriers to appropriate patient progression and coordinate resolution.

· Review patient cases for compliance with payer and regulatory guidelines.

· Support appropriate reimbursement from Medicare, Medicaid, and commercial insurance plans.

· Apply knowledge of CMS requirements to inpatient care and utilization review activities.

· Assist with denial prevention and identify documentation issues that may affect reimbursement.

· Communicate with payers and utilization review representatives when required.

· Participate in interdisciplinary rounds and patient-care discussions.

· Support safe and appropriate transitions between levels of care.

· Identify quality, risk, or patient-safety concerns through medical record review.

· Escalate cases requiring physician, leadership, or multidisciplinary review.

· Maintain accurate and timely documentation of utilization and care-coordination activities.

· Protect confidential patient information and comply with all privacy requirements.

· Collaborate effectively with providers, nursing staff, patients, case managers, and hospital leadership.

Required Qualifications

Candidates must have:

· Active and unrestricted Alaska Registered Nurse (RN) license

· Bachelor of Science in Nursing (BSN)

· Minimum 8 years of clinical nursing or patient-care experience

· Minimum 3 years of experience in one or more of the following:

o Medical record/chart review

o Utilization review or utilization management

o Risk management

o Quality management

o Case management

o Related healthcare quality services

· Current BLS – American Heart Association

· Current ACLS – American Heart Association

· Strong knowledge of medical terminology, anatomy, physiology, and disease processes

· Strong written and verbal communication skills

· Excellent organizational and prioritization abilities

· Ability to independently evaluate complex clinical information

Required Utilization Review Knowledge

Candidates should have experience with:

· Medical necessity review

· Level-of-care determination

· Inpatient chart review

· Concurrent review

· Continued-stay review

· Healthcare reimbursement requirements

· Public and private insurance processes

· CMS regulations

· Clinical documentation review

· Risk and quality assessment

· Resource utilization

Coding & Regulatory Knowledge

Candidates should possess working knowledge of:

· ICD coding principles

· CPT coding principles

· Centers for Medicare & Medicaid Services ( CMS ) requirements

· Hospital reimbursement processes

· Medical necessity criteria

· Clinical documentation standards

· Healthcare regulatory requirements

Preferred Qualifications

Strong candidates may also have:

· Case Management certification from a recognized certifying organization

· CCM – Certified Case Manager

· Other recognized utilization management or case management certification

· Previous inpatient hospital case management experience

· Utilization Review RN experience

· Clinical Documentation Improvement experience

· Risk management experience

· Quality improvement experience

· Medicare and Medicaid reimbursement knowledge

· Previous travel nursing experience

Key Skills

Successful candidates should demonstrate strong competency in:

· Inpatient care coordination

· Utilization management

· Utilization review

· Chart review

· Medical necessity

· Level-of-care review

· Case management

· Risk management

· Quality management

· Clinical documentation

· CMS regulations

· Insurance reimbursement

· ICD and CPT terminology

· Interdisciplinary collaboration

· Patient-care assessment

· Problem solving

· Clinical decision-making

· Professional communication

Schedule Requirements

· Day / Flexible Shift

· Four 10-hour shifts per week

· 40 hours per week

· Exact start and end times may vary based on department needs and patient-care requirements.

Candidates should be comfortable with reasonable scheduling flexibility during the assignment.

Additional Requirements

· Active Alaska RN licensure must be in place for the assignment.

· Flu vaccination is required unless an approved exemption is permitted under facility policy.

· All required certifications and licenses must remain current throughout the contract.

Ideal Candidate

The ideal candidate is an experienced RN with a strong clinical background who has transitioned into utilization review, inpatient care coordination, case management, quality, or risk management .

You should be comfortable reviewing complex medical records, determining medical necessity and level of care, communicating with physicians and payers, and navigating regulatory and reimbursement requirements.

This opportunity may be a strong fit for professionals currently working as an:

· RN Inpatient Care Coordinator

· Utilization Review RN

· Utilization Management RN

· RN Case Manager

· Clinical Care Coordinator

· Hospital Case Manager

· Clinical Documentation RN

· Quality Review RN

· Care Management RN

Equal Opportunity

We are an equal opportunity employer and consider qualified applicants based on education, experience, licensure, certifications, clinical expertise, and the requirements of the position.