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Utilization Review Nurse Specialist

2 months ago

Albany, New York, United States Albany Medical Center Full time
Job Summary

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 efficient and effective delivery of patient care.

Key Responsibilities
  • Conduct thorough utilization reviews to identify opportunities for improvement in patient care and resource utilization.
  • Apply MCG criteria to assess the appropriateness of admissions and continued stays, and document findings in accordance with departmental standards.
  • Collaborate with healthcare teams to identify areas for clinical documentation improvement and implement changes as needed.
  • Monitor length of stay (LOS) and ancillary resource use, and take proactive steps to achieve continuous improvement in these areas.
  • Communicate with payors to resolve issues and ensure timely reimbursement for assigned patients.
  • Use quality screens to identify potential issues and forward information to the Quality Department for further review.
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.
  • Case Management certification preferred.
About Albany Medical Center

Albany Medical Center is an equal opportunity employer committed to providing a work environment that is free from discrimination and harassment. We are dedicated to fostering a culture of diversity, equity, and inclusion, and we welcome applications from qualified candidates from diverse backgrounds.