Utilization Review Nurse Specialist
5 days ago
Albany Medical Center is seeking a skilled Utilization Review Nurse to join our team.
Job Summary:The Utilization Review Nurse will be responsible for conducting thorough reviews of patient admissions and continued stays to ensure appropriateness and quality of care. This role requires strong analytical and problem-solving skills, as well as excellent communication and collaboration skills.
Key Responsibilities:- Conduct utilization reviews to identify areas for improvement and optimize resource utilization
- Apply MCG criteria to monitor appropriateness of admissions and continued stays
- Collaborate with healthcare teams to ensure seamless care transitions and optimal patient outcomes
- Communicate with payors and resolve issues related to coverage and reimbursement
- Identify and report potential issues and delays 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
- Case Management certification preferred
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.
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