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Clinical Utilization Review Nurse Specialist

2 months ago

Greenbush, Maine, United States Albany Medical Center Full time
Job Summary

We are seeking a highly skilled Clinical Utilization Review Nurse to join our team at Albany Medical Center. As a key member of our Care Management/Social Work department, you will be responsible for conducting thorough utilization reviews, quality screenings, and delay management for assigned patients.

Key Responsibilities
  • Apply MCG criteria to assess the appropriateness of admissions and continued stays
  • Identify areas for clinical documentation improvement and collaborate with the healthcare team to manage care across the continuum
  • Communicate effectively with the Quality Department, Medical Director, and Triad Team
  • Address issues with payors and facilitate the removal of delays
Requirements
  • 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
What We Offer

Albany Medical Center is an equal opportunity employer and offers a competitive salary and benefits package. 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.