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Clinical Utilization Review Nurse

2 months ago

Glenmont, United States Albany Medical Center Full time

Department/Unit: Care Management/Social Work

Responsibilities:

  • Conduct utilization management and quality screening for assigned patients
  • Apply MCG criteria to assess appropriateness of admissions and continued stays
  • Identify areas for clinical documentation improvement and collaborate with relevant departments
  • Monitor length of stay and resource use, taking actions to improve efficiency
  • Refer cases to Medical Director and Triad Team as per procedures
  • Communicate reimbursement certification for assigned patients
  • Collaborate with healthcare team to manage care across the continuum

Minimum Qualifications:

  • Registered nurse with a New York State license
  • Bachelor's degree preferred
  • Minimum three years clinical experience
  • Recent experience in case management, utilization management, or discharge planning
  • Assertive and creative problem solving skills
  • Proficiency in computer systems and MCG criteria
  • Understanding of Medicare regulatory requirements and Managed Care Plans

Thank you for your interest in Albany Medical Center Albany Medical is an equal opportunity employer.