Job Description

Our mission is excellence in healthcare services and the promotion of wellness in our community. Our Guiding values are Integrity, Professionalism, Teamwork and Quality.

Job Description

Swing Bed Coordinator / Hospital Discharge Planner / Utilization Review Nurse

Department

Acute Care / Swing bed

Reports To

Chief Nursing Officer (CNO)

Job Summary

Responsible for hospital-wide discharge planning and utilization review for all Critical Access Hospital (CAH) inpatients, observation, and swing bed patients, and for coordination of the Swing bed Program in compliance with CMS Conditions of Participation (Appendix W). This role supports medically necessary utilization, safe care transitions, regulatory compliance, financial stewardship, and patient-centered care from admission through discharge.

Essential Duties amp; Responsibilities

A. Hospital - Wide Discharge Planning (All CAH Patients)

• Serves as primary discharge planner for all acute, observation, and swing bed patients
• Initiates discharge planning at admission with documented needs assessment
• Coordinates post-discharge services (home health, DME, appointments, transportation, community resources)
• Provides patient /family education on diagnosis, medications, warning signs, and follow-up
• Facilities transfer to appropriate levels of care: Swing bed, SNF, home, or assisted living
• Ensures advance directives are offered and documented
• Promotes timely, safe, and efficient transitions of care

B. Hospital-Wide Utilization Review (all CAH Patients)

• Conducts admission and concurrent utilization review for medical necessity, status, level of care, and length of stay
• Ensures documentation supports continued hospitalization and skilled services
• Collaborates with providers, nursing, therapy, and leadership
• Identifies delayed discharges, barriers to placement, and avoidable days
• Issues required Medicare notices (Moon, NOMNC, etc.)
• Maintains compliance with Appendix W and Medicare Benefit Policy
• Supports compliant revenue integrity

C. Swing bed Program Coordination

• Coordinates Swing bed admissions and ongoing case management
• Screens for qualifying stay, skilled eligibility, and payor authorization
• Coordinates, attends, and documents IDT care conferences
• Orients patients and families to program expectations, rights, financial responsibility, and discharge planning
• Collaborates with providers, nursing, therapy, pharmacy, dietary, and families
• Issues Skilled Notices of Non-Coverage as required
• Tracks admissions, days, payor mix, outcomes, and discharge destinations

D. Regulatory, Survey amp; Quality

• Ensures compliance with CMS Appendix W, Alaska regulations, and PMC policies
• Participates in state/federal surveys, audits, and utilization reviews
• Assists with grievances and abuse/neglect reviews as applicable
• Participate in quality improvement activities and committees

E. Communication amp; Care Coordination

• Serves as liaison between patients, families, providers, nursing, therapy, and community agencies
• Participates in interdisciplinary rounds and care conferences
• Communicates discharge plans, utilization issues, and care barriers

Professional Standards amp; Conduct

• Maintains confidentiality
• Promotes patient rights, dignity, and informed decision-making
• Demonstrates professionalism, empathy, and sound judgment
• Supports PMC's mission, vision, and values

Minimum Qualifications

• Current, unrestricted Alaska RN license
• Minimum 2 years' clinical nursing experience (acute care, rehab, LTC, case management, or care management preferred)
• Working knowledge of discharge planning, utilization review, medical necessity, Appendix W, and Swing bed rules and regulations
• Strong assessment, documentation, communication, and organizational skills
• Proficiency with EHR systems
• Ability to maintain confidentiality and exercise independent clinical judgment

Preferred Qualifications

• Experience in discharge planning, utilization review, Swing bed coordination, or payor eligibility
• Critical Access Hospital experience

Physical Demands

• Ability to sit, stand, walk, use computers extensively, communicate effectively, and manage frequent interruptions with time-sensitive priority

Requirements for employment include --

• Background Check. Employment is contingent upon the successful completion of a background investigation conducted through the State of Alaska in accordance with applicable regulations.
• Drug Screening. All employees must successfully complete a pre-employment drug screening, which includes testing for marijuana.
• Immunization Compliance. Employees are required to meet all immunization requirements as mandated by the State of Alaska and Federal regulations governing healthcare facilities.

**Position will remain open until filled.

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