Healthcare Risk Management Jobs in Alaska (NOW HIRING)

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.