Utilization Review Nurse
2 weeks ago
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 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.
Minimum Qualifications:
• Registered nurse with a New York State current license. • Bachelor's degree preferred • Minimum of three years clinical experience in an assigned service. • Recent experience in case management, utilization management and/or discharge planning/home care in a high volume, acute care hospital preferred. PRI and • Case Management certification preferred. • Assertive and creative in problem solving, critical thinking skills, systems planning and patient care management. • Self-directed with the ability to adapt in a changing environment. • Basic knowledge of computer systems with skills applicable to utilization review process. • Excellent written and verbal communication skills. • Working knowledge of MCG criteria and ability to implement and utilize. • Understanding of Inpatient versus Outpatient surgery and ICD10-Coding (preferred) and Observation status qualifications. • Ability to work independently and demonstrate organizational and time management skills. • Strong analytic, data management and PC skills. • Working knowledge of Medicare regulatory requirements, Managed Care Plans
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
24 hours ago
wynantskill, United States Albany Medical Center Full timeWynantskill, NY, United States Department/Unit: Care Management/Social WorkWork 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
2 weeks ago
Wynantskill, New York, United States Albany Medical Center Full timeJob 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
2 weeks ago
Wynantskill, New York, United States Albany Medical Center Full timeJob Title: Utilization Review NurseAlbany Medical Center is seeking a skilled Utilization Review Nurse to join our team. 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.Responsibilities:Conduct thorough reviews of patient admissions and continued stays to...
-
Utilization Review Nurse Specialist
2 weeks ago
Wynantskill, New York, United States Albany Medical Center Full timeJob 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
3 weeks ago
Wynantskill, New York, United States Albany Medical Center Full timeJob SummaryWe are seeking a skilled Utilization Review Nurse to join our Care Management team at Albany Medical Center. As a key member of our team, you will be responsible for ensuring the efficient and effective use of healthcare resources while maintaining high-quality patient care.Key ResponsibilitiesConduct thorough utilization reviews to identify...
-
Clinical Utilization Specialist
3 weeks ago
Wynantskill, New York, United States Albany Medical Center Full timeJob SummaryWe are seeking a skilled Clinical Utilization Specialist 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 delivery of patient care.Key ResponsibilitiesConduct thorough utilization reviews to identify opportunities for improvement in...
-
(RN) Cart Nurse
9 hours ago
Wynantskill, United States Quality Talent Group Full timeAbout the job (RN) Cart Nurse - Registered Nurse Registered Nurse (RN) Cart NurseDelmar Center for Rehabilitation and Healthcare is seeking a Registered Nurse (RN) Cart Nurse to work for our skilled nursing facility in Delmar, NY!DUTIES: Provides advice & support to the Residents and their families. Monitoring Residents and administering medication and...
-
RN Unit Manager Registered Nurse
2 weeks ago
Wynantskill, United States Troy Center Full timeJob DescriptionJob DescriptionTroy Center is hiring a Registered Nurse (RN) Unit Manager in Troy, NY. We are now offering a $3,000 sign-on bonus!!! Duties: Handle all supervisory duties for assigned unit Help establish and implement employee policies and procedures Mentor less experienced nurses, offering clinical & career advice Maintain the standards...
-
Advanced Practice Registered Nurse
4 weeks ago
Wynantskill, New York, United States Albany Medical Center Full timeJob SummaryAlbany Medical Center is seeking a highly skilled Nurse Practitioner to join our team in the Anesthesiology Department. As a key member of our interdisciplinary team, you will be responsible for providing high-quality patient care, managing acute pain services, and collaborating with healthcare providers to ensure seamless patient care.Key...
-
Veterinary Nurse Position
5 days ago
Wynantskill, New York, United States EverVet Partners Full timeJob SummaryWe are seeking a highly skilled and compassionate Veterinary Nurse to join our team at EverVet Partners. As a Veterinary Nurse, you will play a vital role in providing exceptional care to our patients and their owners. Your responsibilities will include assisting veterinarians and technicians, managing patient restraint, aiding in radiology,...
-
Wynantskill, United States Hueman Risk Adjustment Full timeJob DescriptionJob DescriptionHueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Wynantskill, NY. This unique opportunity adapts to your lifestyle, giving you the freedom to achieve your professional goals on your terms, all while enjoying...
-
(RN) Clinical Supervisor, ICU
2 weeks ago
Wynantskill, United States Troy Center Full timeJob DescriptionJob DescriptionRegistered Nurse (RN) Supervisor: Night ShiftTroy Center is looking to hire an RN Supervisor to work the Night Shift (11 PM - 7 AM) at our Skilled Nursing Facility in Troy, NY. New Grads Welcome! Now offering $2,500 Sign On Bonus! DUTIES:Provides advice & support to the Residents and their families.Monitoring Residents and...
