RN Utilization & Care Coordination Specialist

Graceworks Lutheran Services; Kotzebue (AK); On-site; USD 90,000 - 110,000; Full time

Job summary

Maniilaq Association in Kotzebue, AK seeks an Utilization Management Nurse (UMN) to lead utilization review and risk management within the care team. You will coordinate DME and pharmacy prior authorizations, support quality initiatives, and collaborate with physicians and nursing staff.

The UMN develops and implements plans, monitors outcomes, and contributes to IPC4 program activities while reporting to the CMO/CNO as needed.

Qualifications

• Must be a currently licensed RN with at least two years of related experience in case management, utilization review, discharge planning, or quality improvement.
• Knowledge of acute and chronic illnesses, specialty clinic procedures, and community health nursing.
• Proficient with Cerner and Microsoft Office; able to pass core competencies and work autonomously.

Responsibilities

• Coordinate IPC4 process in Medicare/Medicaid and private insurances.
• Assist revenue procurement by ensuring insurance approvals and identifying alternate funding sources.
• Chairs Quarterly Utilization Review Committee meetings to improve resource utilization.
• Submit Quarterly reports to CMO and CNO for Board meetings.
• Collaborate with coders, billers, and providers to ensure accurate, timely billing information.
• Develop and maintain a resource database of federal, state, and community resources.
• Participate in Medicaid Task Force and Quality Improvement projects.

Skills

Case Management

Utilization Review

Discharge Planning

Quality Improvement

Autonomy

Communication

Education

RN licensure (state)

Tools

Cerner

Microsoft Office

Job description

Maniilaq Association in Kotzebue, AK seeks an Utilization Management Nurse (UMN) to lead utilization review and risk management within the care team. You will coordinate DME and pharmacy prior authorizations, support quality initiatives, and collaborate with physicians and nursing staff.

The UMN develops and implements plans, monitors outcomes, and contributes to IPC4 program activities while reporting to the CMO/CNO as needed.