Current jobs related to Clinical Utilization Review Nurse - Albany, New York - Albany Medical Center
-
Utilization Review Nurse
4 weeks ago
Albany, New York, United States Medix™ Full timeJob Title: Clinical Utilization ReviewerLocation: Flexible work arrangements available, including hybrid and fully onsite options.Job Summary:We are seeking a skilled Clinical Utilization Reviewer to join our team at Medix™. As a Clinical Utilization Reviewer, you will be responsible for reviewing medical claims and making determinations on the...
-
Utilization Review Nurse
4 weeks ago
Albany, New York, United States Albany Medical Center Full timeJob SummaryAlbany Medical Center is seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will be responsible for reviewing patient admissions and continued stays to ensure they meet medical necessity and are appropriate for the level of care provided.Key ResponsibilitiesConduct thorough reviews of patient admissions...
-
Utilization Review Nurse
4 weeks ago
Albany, New York, United States Medix™ Full timeJob Title: Clinical Utilization ReviewerLocation: Flexible work arrangements available, including hybrid and fully onsite options.Job Summary:We are seeking a skilled Clinical Utilization Reviewer to join our team at Medix™. As a Clinical Utilization Reviewer, you will be responsible for reviewing medical documentation, codes, and other evidence to make...
-
Utilization Review Nurse Specialist
1 month ago
Albany, 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 Utilization Review Nurse, you will play a critical role in ensuring that patients receive the most appropriate care while minimizing unnecessary costs.Key Responsibilities:Conduct thorough reviews of patient records to identify areas...
-
Utilization Review Nurse Specialist
1 month ago
Albany, 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 Utilization Review Nurse, you will play a critical role in ensuring that patients receive the most appropriate care while minimizing unnecessary costs.Key Responsibilities:Conduct thorough reviews of patient records to identify areas...
-
Utilization Review Nurse Specialist
1 month ago
Albany, 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 Utilization Review Nurse, you will play a critical role in ensuring that patients receive the most appropriate care while minimizing unnecessary costs.Key Responsibilities:Conduct thorough reviews of patient records to identify areas...
-
Utilization Review Nurse Specialist
4 weeks ago
Albany, New York, United States Albany Med Full timeJob SummaryWe are seeking a skilled Utilization Review Nurse to join our team at Albany Medical Center. As a Utilization Review Nurse, you will play a critical role in ensuring the efficient and effective use of healthcare resources.Key ResponsibilitiesConduct thorough reviews of patient records to identify opportunities for cost savings and quality...
-
Utilization Review Nurse Specialist
1 month ago
Albany, 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
1 month ago
Albany, 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...
-
Clinical Utilization Review Specialist
3 weeks ago
Albany, New York, United States Medix Full timeJob Title:Utilization Management / Appeals RNLocation:Highly preferred for nurses to work in the office in either Lake Success or Albany***open to hybrid or fully onsiteHours:M-F 8-5Pay:$48-52/hr+ (negotiable)Experience:UM, Appeals, or strong analytical background to do claims adjudication.Need a BSN and ~2 years of experience.Responsibilities:Review and...
-
Utilization Review Nurse Specialist
1 month ago
Albany, 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...
-
Clinical Reviewer RN
4 weeks ago
Albany, New York, United States Greenlife Healthcare Staffing Full timeJob OpportunityWe are seeking a skilled Registered Nurse Clinical Reviewer to join our team at Greenlife Healthcare Staffing.Job SummaryThe successful candidate will conduct thorough reviews of medical records, ensuring compliance with regulatory guidelines and insurer requirements. They will also provide technical assistance and training to administrative...
-
Clinical Reviewer
1 week ago
Albany, New York, United States Greenlife Healthcare Staffing Full timeJob Title: Clinical Reviewer - Medical ProfessionalJob Description:We are seeking a skilled Clinical Reviewer to join our team at Greenlife Healthcare Staffing. As a Clinical Reviewer, you will be responsible for conducting reviews up to and including the appeal level, compiling regulatory guidance, researching insurer requirements, and preparing final...
-
Albany, New York, United States GreenLife Healthcare Staffing Full timeMedical Reviewer Job for Registered NurseWe are seeking a Registered Nurse with experience in medical review to join our team at GreenLife Healthcare Staffing. This is a full-time position with a 6-month contract, with the possibility of extension based on client demand and employee performance.Responsibilities:Conduct reviews up to and including the appeal...
-
Utilization Management Nurse Consultant
2 weeks ago
Albany, New York, United States CVS Health Full timeTransforming Healthcare with CVS HealthAt CVS Health, we're committed to delivering innovative healthcare solutions that make a meaningful difference in people's lives. As a Utilization Management Nurse Consultant, you'll play a vital role in shaping our mission to bring heart to every moment of our patients' health.Job SummaryThis 100% remote position...
-
Utilization Management Nurse
2 weeks ago
Albany, New York, United States Baptist Health Full timeJob Summary:We are seeking a skilled Utilization Management Registered Nurse to join our team at Baptist Health Floyd. As a Utilization Management Nurse, you will play a critical role in ensuring the quality and efficiency of patient care. Key Responsibilities:* Conduct thorough utilization reviews of patient admissions, length of stay, and services ordered...
-
Utilization Management Nurse Consultant
1 month ago
Albany, New York, United States CVS Health Full timeJob SummaryCVS Health is seeking a highly skilled Utilization Management Nurse Consultant to join our team. As a Utilization Management Nurse Consultant, you will play a critical role in ensuring that our members receive the most appropriate care at the right time and in the right setting.Key ResponsibilitiesUtilize clinical expertise to assess, plan,...
-
Utilization Management Nurse Consultant
4 weeks ago
Albany, New York, United States CVS Health Full timeJob SummaryCVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a key member of our utilization management team, you will play a critical role in ensuring that our members receive the most appropriate care at the right time and in the right setting.Key ResponsibilitiesUtilize clinical expertise to coordinate, document,...
-
Medical Review Specialist
2 weeks ago
Albany, New York, United States InGenesis Full timeJob Title: Registered NurseInGenesis is seeking a highly skilled Registered Nurse to join our team in Albany, NY. As a key member of our client's team, you will be responsible for conducting medical reviews, investigating complaints, and developing investigative plans.Key Responsibilities:Perform medical reviews of clinical records to identify...
-
Medical Review Specialist
2 weeks ago
Albany, New York, United States InGenesis Full timeJob SummaryWe are seeking a highly skilled Registered Nurse to join our team as a Medical Review Specialist. In this role, you will be responsible for conducting medical reviews, investigating complaints, and developing investigative plans for cases involving violations of NYS Public Health Law, Section 230.Key ResponsibilitiesPerform medical reviews,...
Clinical Utilization Review Nurse
2 months ago
As a Clinical Utilization Review Nurse, you will play a vital role in the management of patient care by overseeing Utilization Management, Quality Screening, and Delay Management for designated patients.
Key Responsibilities:
- Conduct Utilization Management and Quality Screening for assigned patients.
- Utilize MCG criteria to assess the appropriateness of admissions and ongoing stays, documenting findings in accordance with departmental standards.
- Identify opportunities for clinical documentation enhancement during utilization reviews and engage with relevant departments.
- Recognize at-risk populations through approved screening tools and adhere to established reporting protocols.
- Continuously monitor Length of Stay (LOS) and ancillary resource utilization, implementing strategies for ongoing improvement.
- Refer cases and concerns to the Medical Director and Triad Team as per departmental procedures, ensuring appropriate follow-up.
- Communicate reimbursement certification for covered days for assigned patients.
- Engage with clinical staff to discuss payor criteria and issues on a case-by-case basis, resolving problems with payors as necessary.
- Employ quality screens to detect potential issues and relay information to the Quality Department.
- Exhibit proficient use of MCG and documentation standards through case reviews and inter-rater reliability assessments.
- Facilitate the removal of delays and document any existing delays, reporting both internal and external delays to the Triad Team.
- Collaborate with the healthcare team and relevant departments to manage care across the continuum, ensuring effective communication with the Triad Team and healthcare professionals.
This position may require access to sensitive information related to Albany Medical Center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other data regulated by Federal and New York State laws.
Confidentiality Expectations:
Workforce members are expected to ensure that:
- Access to information is based on a "need to know" basis and is limited to the minimum necessary to perform assigned duties.
- Use or disclosure shall not exceed the minimum amount of information required to achieve the intended purpose.
- Reasonable efforts, consistent with Albany Medical Center policies and standards, shall be made to protect information from unauthorized access and modification.
