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Case Manager / Utilization Review Navigator

Expired Job

Providence Health & Services Kodiak , AK 99615

Posted 3 months ago

Providence is calling a Case Manager/Registered Nurse (RN) Navigator to Providence Kodiak Island Medical Center in Kodiak, Alaska.

The Case Manager / Utilization Review Navigator is responsible for the comprehensive assessment, planning, implementation, and evaluation of individual patient needs for discharge planning, admission to swing bed and case management including utilization review in accordance with Providence philosophy, objectives, policies, procedures and standards.

In this position you will:

  • Assist in management of resources with informational and monitoring tool(s) that support access, confidentiality, and assessment, analysis of care and throughput, intervention, efficiencies, and quality of care.

  • Interface with external review companies and consultants, using advocacy and negotiating skills that address medical necessity and appropriateness of inpatient/outpatient levels of care.

  • Communicate with physicians at regular intervals throughout hospitalization and develop an effective working relationship to assist the physicians to maintain appropriate cost and desired patient outcomes.

  • Correlate organizational data on length of stay, avoidable days, denial days, readmissions, admission referrals, and RAC denials with Utilization reviewer reporting to Case Management Manager.

  • Demonstrate commitment to teamwork and interact harmoniously with others to ensure team success.

  • Ensure an effective purchasing process is maintained by requisitioning necessary products and supplies for personnel, determining necessary quality/quantity requirements, selecting suppliers according to current contracting, arranging for deliveries, following up on orders, dispensing of equipment and other items when necessary.

Required qualifications for this position include:

  • Graduate of an accredited/approved school of Nursing. Associates Degree in Nursing

  • Licensed as a Registered Nurse in the State of Alaska

  • Basic Life Support (BLS) certification within 90 days of hire

  • Current driver's license with a clean driving record and proof of current vehicle insurance

  • 3 years of clinical nursing experience

  • Compass training to be completed within 1 year from date of hire

Preferred qualifications for this position include:

  • Bachelor degree

  • Case Management certification

  • 1 year of experience as an RN in Utilization Management-review, Case Management and/or Discharge-planning experience

  • Experience with InterQual criteria, Medicare and Medicaid regulations

  • Prior experience using Electronic Medical Records (EMR) such as EPIC

  • Prior experience using Microsoft Office Suite

About Kodiak Island Medical Center

Providence Kodiak Island Medical Center (PKIMC) provides comprehensive health care to residents and visitors of Kodiak Island. This critical access hospital features 25 acute care beds, including four birthing suites, one OB triage room, and two ICU beds. In addition, the Elder House, PKIMC's long term care facility, has 22 beds.

PKIMC provides an extensive array of inpatient and outpatient services, including emergency department, surgery, laboratory services, maternity, general medicine, physical therapy, occupational therapy, respiratory therapy, sleep studies, specialty clinics, diagnostic imaging services and pharmacy and is staffed by a mix of primary care physicians, surgeons and specialists who provide family practice, internal medicine, obstetrics, radiology and general practice.

For more information regarding Providence Kodiak Island Medical Center, please click on the following link:

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Case Manager / Utilization Review Navigator

Expired Job

Providence Health & Services