Utilization Review Nurse

4 months ago

Albany, United States Albany Medical Center Full time

43 New Scotland Avenue Albany, NY 12208

Department/Unit:

Care Management/Social Work

Work Shift:

Day (United States of America)

Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients.

Salary Range: $31.28 - $51.61 per hour

• Completes Utilization Management and Quality Screening for assigned patients.
• Applies MCG criteria to monitor appropriateness of admissions and continued stays, and documents findings based on Departmental standards.
• While performing utilization review identifies areas for clinical documentation improvement and contacts appropriate department.
• Identifies at-risk populations using approved screening tool and follows established reporting procedures.
• Monitors LOS and ancillary resource use on an ongoing basis. Takes actions to achieve continuous improvement in both areas.
• Refers cases and issues to Medical Director and Triad Team in compliance with Department procedures and follows up as indicated.
• Communicates covered day reimbursement certification for assigned patients.
• Discusses payor criteria and issues and a case-by-case basis with clinical staff and follows up to resolve problems with payors as needed.
• Uses quality screens to identify potential issues and forwards information to the Quality Department.
• Demonstrates proper use of MCG and documentation requirements through case review and inter-rater reliability studies.
• Facilitates removal of delays and documents delays when they exist. Reports internal and external delays to the Triad Team.
• Collaborates with the health care team and appropriate department in the management of care across the continuum of care by assuring communication with Triad Team and health care team

Thank you for your interest in Albany Medical Center​

Albany Medical is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:

Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.

  • Utilization Review Nurse

    7 days ago

    Albany, New York, United States Albany Medical Center Full time

    Job SummaryWe are seeking a skilled Utilization Review Nurse to join our team at Albany Medical Center. As a key member of our Care Management/Social Work department, you will play a critical role in ensuring the efficient and effective delivery of patient care.Key ResponsibilitiesConduct thorough utilization reviews to identify opportunities for improvement...

  • Utilization Review Nurse

    7 days ago

    Albany, New York, United States Albany Medical Center Full time

    Job SummaryWe are seeking a skilled Utilization Review Nurse to join our team at Albany Medical Center. As a key member of our Care Management/Social Work department, you will play a critical role in ensuring the efficient and effective delivery of patient care.Key ResponsibilitiesConduct thorough utilization reviews to identify opportunities for improvement...

  • Utilization Review Nurse Specialist

    1 day ago

    Albany, New York, United States Albany Medical Center Full time

    Job Title: Utilization Review NurseAlbany Medical Center is seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring that patients receive the most appropriate care while minimizing unnecessary costs.Key Responsibilities:Conduct thorough reviews of patient records to identify areas...

  • Utilization Review Nurse Specialist

    9 hours ago

    Albany, New York, United States Albany Medical Center Full time

    Job Title: Utilization Review NurseAlbany Medical Center is seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring that patients receive the most appropriate care while minimizing unnecessary costs.Key Responsibilities:Conduct thorough reviews of patient records to identify areas...

  • Utilization Review Nurse Specialist

    8 hours ago

    Albany, New York, United States Albany Medical Center Full time

    Job Title: Utilization Review NurseAlbany Medical Center is seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring that patients receive the most appropriate care while minimizing unnecessary costs.Key Responsibilities:Conduct thorough reviews of patient records to identify areas...

  • Utilization Review Nurse

    3 days ago

    Albany, United States Albany Medical Center Full time

    43 New Scotland Avenue Department/Unit: Care Management/Social Work Work Shift: Day (United States of America) Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients. Salary: $65,062.40 -$107,348.80• Completes Utilization Management and Quality Screening for assigned patients. • Applies MCG criteria to...

  • Utilization Review Nurse Specialist

    1 week ago

    Albany, New York, United States Albany Medical Center Full time

    Job SummaryWe are seeking a skilled Utilization Review Nurse to join our team at Albany Medical Center. As a key member of our Care Management/Social Work department, you will play a critical role in ensuring the efficient and effective delivery of patient care.Key ResponsibilitiesConduct thorough utilization reviews to identify opportunities for improvement...

  • Utilization Review Nurse Specialist

    1 week ago

    Albany, New York, United States Albany Medical Center Full time

    Job SummaryWe are seeking a skilled Utilization Review Nurse to join our team at Albany Medical Center. As a key member of our Care Management/Social Work department, you will play a critical role in ensuring the efficient and effective delivery of patient care.Key ResponsibilitiesConduct thorough utilization reviews to identify opportunities for improvement...

  • Utilization Review Nurse Specialist

    1 week ago

    Albany, New York, United States Albany Medical Center Full time

    Job SummaryWe are seeking a skilled Utilization Review Nurse to join our team at Albany Medical Center. As a key member of our Care Management/Social Work department, you will play a critical role in ensuring the efficient and effective delivery of patient care.Key ResponsibilitiesConduct thorough utilization reviews to identify opportunities for improvement...

  • Utilization Review Nurse Specialist

    1 week ago

    Albany, New York, United States Albany Medical Center Full time

    Job SummaryWe are seeking a skilled Utilization Review Nurse to join our team at Albany Medical Center. As a Utilization Review Nurse, you will play a critical role in ensuring the efficient use of healthcare resources while maintaining high-quality patient care.Key ResponsibilitiesConduct thorough reviews of patient admissions and continued stays to ensure...

  • Utilization Review Nurse Specialist

    3 days ago

    Albany, New York, United States Albany Medical Center Full time

    Job SummaryAlbany Medical Center seeks a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will be responsible for ensuring that patients receive the most appropriate care while minimizing unnecessary costs.Key ResponsibilitiesConduct thorough reviews of patient records to identify areas for improvement in care and...

  • Utilization Review Nurse Specialist

    1 day ago

    Albany, New York, United States Albany Medical Center Full time

    Job SummaryWe are seeking a skilled Utilization Review Nurse to join our team at Albany Medical Center. As a key member of our Care Management department, you will play a critical role in ensuring the efficient and effective use of healthcare resources.Key ResponsibilitiesConduct thorough utilization reviews to identify opportunities for improvement in...

  • Utilization Review Nurse Specialist

    1 day ago

    Albany, New York, United States Albany Medical Center Full time

    Job SummaryWe are seeking a skilled Utilization Review Nurse to join our team at Albany Medical Center. As a key member of our Care Management department, you will play a critical role in ensuring the efficient and effective use of healthcare resources.Key ResponsibilitiesConduct thorough utilization reviews to identify opportunities for improvement in...

  • Utilization Review Nurse Specialist

    13 hours ago

    Albany, New York, United States Albany Medical Center Full time

    Job SummaryWe are seeking a skilled Utilization Review Nurse to join our team at Albany Medical Center. As a key member of our Care Management department, you will play a critical role in ensuring the efficient and effective use of healthcare resources.Key ResponsibilitiesConduct thorough utilization reviews to identify opportunities for improvement in...

  • Clinical Utilization Review Nurse

    3 weeks ago

    Albany, New York, United States Albany Medical Center Full time

    Position Overview:As a Clinical Utilization Review Nurse, you will play a vital role in the management of patient care by overseeing Utilization Management, Quality Screening, and Delay Management for designated patients.Key Responsibilities:Conduct Utilization Management and Quality Screening for assigned patients.Utilize MCG criteria to assess the...

  • Utilization Review Nurse

    1 month ago

    Albany, United States Albany Medical Center Full time

    43 New Scotland Avenue Albany, NY 12208Department/Unit:Care Management/Social WorkWork Shift:Day (United States of America)Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients.Salary Range: $31.28 - $51.61 per hour• Completes Utilization Management and Quality Screening for assigned patients.• Applies MCG...

  • Utilization Review Nurse

    4 months ago

    Albany, United States Albany Medical Center Full time

    43 New Scotland Avenue Albany, NY 12208Department/Unit:Care Management/Social WorkWork Shift:Day (United States of America)Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients.Salary Range: $31.28 - $51.61 per hour• Completes Utilization Management and Quality Screening for assigned patients.• Applies MCG...

  • Clinical Utilization Review Specialist

    4 days ago

    Albany, New York, United States Albany Medical Center Full time

    Job SummaryWe are seeking a skilled Clinical Utilization Review Specialist to join our team at Albany Medical Center. As a key member of our Care Management/Social Work department, you will play a critical role in ensuring the highest quality patient care while optimizing resource utilization.Key ResponsibilitiesConduct thorough utilization reviews to ensure...

  • Clinical Utilization Review Specialist

    2 weeks ago

    Albany, New York, United States Albany Medical Center Full time

    Job SummaryAlbany Medical Center is seeking a skilled Clinical Utilization Review Specialist to join our team. As a key member of our Care Management department, you will play a critical role in ensuring the quality and appropriateness of patient care.Key ResponsibilitiesConduct thorough reviews of patient records to identify areas for improvement in...

  • Utilization Review Nurse

    4 months ago

    Albany, NY, United States Albany Medical Center Full time

    43 New Scotland Avenue Albany, NY 12208 Department/Unit: Care Management/Social Work Work Shift: Day (United States of America) Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients. Salary Range: $31.28 - $51.61 per hour • Completes Utilization Management and Quality Screening for assigned patients. •...