Clinical Utilization Review Specialist
2 weeks ago
We are seeking a skilled Utilization Review Nurse to join our team at Albany Medical Center. As a key member of our Care Management/Social Work department, you will play a critical role in ensuring the highest quality patient care while optimizing resource utilization.
Key Responsibilities- Conduct thorough utilization reviews to identify opportunities for improvement in patient care and resource allocation.
- Collaborate with healthcare teams to develop and implement effective care plans that meet patient needs and optimize resource utilization.
- Apply MCG criteria to monitor appropriateness of admissions and continued stays, and document findings based on departmental standards.
- Identify at-risk populations using approved screening tools and follow established reporting procedures.
- Monitor length of stay (LOS) and ancillary resource use, taking actions to achieve continuous improvement in both areas.
- Communicate with payors and clinical staff to resolve issues and ensure seamless care transitions.
- Use quality screens to identify potential issues and forward information to the Quality Department.
- 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.
- Assertive and creative problem-solving skills, critical thinking, 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.
Albany Medical Center is an equal opportunity employer committed to providing a work environment that is inclusive and respectful of all employees. This role may require access to sensitive information, and workforce members are expected to ensure that access is based on a 'need to know' and is the minimum necessary to properly perform assigned duties.
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Utilization Review Nurse Specialist
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Rexford, 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...
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Utilization Review Nurse Specialist
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Rexford, 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...
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Utilization Review Nurse
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