Utilization Review and Quality Assurance Coordinator

2 days ago


Brooklyn, New York, United States SUNY Downstate Medical Center Full time

About the Job

SUNY Downstate Health Sciences University is seeking an experienced Utilization Review Nurse / TH Utilization Review/Quality Assurance Senior Coordinator to join our Department of Care Management. This full-time position will play a critical role in ensuring the quality and efficiency of patient care.

Job Summary

  • Utilize clinical expertise to review patient cases and determine medical necessity and appropriateness of care.
  • Collaborate with the medical team to develop and implement discharge plans and optimize patient outcomes.
  • Conduct regular quality assurance reviews to identify areas for improvement and develop strategies to address them.
  • Develop and maintain strong relationships with payors, hospitals, and other healthcare organizations to ensure seamless care coordination.

Requirements

  • Active New York State Registered Nurse License.
  • PRI Certification.

Preferred Qualifications

  • Graduate degree in the healthcare field.
  • Case Management Certification.

Salary Range: $90,000 - $120,000 per year, based on experience and qualifications.



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