Clinical Utilization Nurse

2 weeks ago


North Chatham, United States Albany Medical Center Full time

Department/Unit: Care Management/Social Work

Responsible for reviewing utilization and quality of care for assigned patients in an acute care hospital setting.

  • Evaluates appropriateness of admissions and continued stays based on MCG criteria
  • Identifies areas for clinical documentation improvement and collaborates with appropriate departments
  • Monitors length of stay and resource use, taking action for continuous improvement
  • Communicates with medical director and payors as needed
  • Identifies and reports at-risk populations using approved screening tools
  • Collaborates with the healthcare team to manage care across the continuum

Minimum Qualifications:

  • Registered nurse with a current license
  • Bachelor's degree preferred
  • Three years clinical experience in an acute care hospital
  • Experience in case management, utilization management, and/or discharge planning preferred
  • Strong critical thinking and problem-solving skills
  • Working knowledge of MCG criteria and Medicare regulatory requirements


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