Clinical Utilization Review Nurse

3 months ago


Feura Bush, United States Albany Medical Center Full time

Department/Unit: Care Management/Social Work

Work Shift: Day

Responsible for managing utilization, quality screening, and care delays for assigned patients.

  • Complete utilization management and quality screening for assigned patients.
  • Apply criteria for appropriateness of admissions and continued stays.
  • Identify areas for clinical documentation improvement and take appropriate action.
  • Monitor length of stay and resource use, taking actions for continuous improvement.
  • Communicate reimbursement certification for assigned patients.
  • Facilitate removal of delays and document when they exist.

Minimum Qualifications:

  • Registered nurse with a current license.
  • Bachelor's degree preferred.
  • Minimum of three years clinical experience.
  • Recent experience in case management, utilization management, or discharge planning preferred.
  • Assertive, creative, and self-directed with strong communication and organizational skills.
  • Basic knowledge of computer systems and utilization review processes.
  • Understanding of Medicare regulatory requirements and Managed Care Plans.


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