Full employer posting
Position: Utilization Review / Case Management Nurse Guaranteed Hours: 40 hours per week
To be discussed during interview Key Requirements Bachelor’s degree in Nursing (BSN). Active Alaska nursing license required at the time of submission. Minimum 8 years of clinical or nursing experience.
At least 3 years of experience in chart review, risk management, utilization review, or related quality services. Case Management certification (CCM or equivalent) preferred. Flu vaccination required.
Main Responsibilities Review patient medical records and assess medical necessity and length of stay. Monitor quality of care and ensure compliance with clinical guidelines and insurance requirements. Coordinate patient care, treatment plans, and timely discharges.
Communicate with physicians, clinical teams, insurance payers, and patients. Handle utilization review appeals, denials, documentation, and compliance reporting. Support quality improvement activities and perform tumor registry functions.