Clinical Utilization Nurse

2 months ago


Round Lake, United States Albany Medical Center Full time

Responsibilities:

  • Conduct utilization management and quality screening for assigned patients
  • Apply criteria to monitor the appropriateness of admissions and continued stays
  • Identify and address areas for clinical documentation improvement
  • Monitor length of stay and ancillary resource use, taking actions to achieve continuous improvement
  • Refer cases to Medical Director as needed
  • Communicate covered day reimbursement certification for assigned patients
  • Identify potential issues using quality screens and forward information to the Quality Department
  • Facilitate removal of delays and document delays when they exist
  • Collaborate with the healthcare team to manage care across the continuum

Minimum Qualifications:

  • Registered nurse with a current license in New York State
  • Bachelor's degree preferred
  • Minimum of three years clinical experience
  • Recent experience in case management, utilization management, or discharge planning in a high-volume acute care hospital
  • Assertive and creative problem-solving skills
  • Self-directed with adaptability in a changing environment
  • Strong analytic, data management, and PC skills
  • Working knowledge of Medicare regulatory requirements and Managed Care Plans


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