Utilization Review Nurse Specialist

2 weeks ago


Wynantskill, New York, United States Albany Medical Center Full time
Job Title: Utilization Review Nurse

Albany Medical Center is seeking a skilled Utilization Review Nurse to join our team. 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.

Responsibilities:
  • Conduct thorough reviews of patient admissions and continued stays to ensure medical necessity and appropriateness of care.
  • Apply MCG criteria to identify areas for clinical documentation improvement and communicate findings to the healthcare team.
  • Identify at-risk populations and implement strategies to improve patient outcomes and reduce length of stay.
  • Collaborate with the healthcare team to develop and implement individualized care plans that meet the unique needs of each patient.
  • Communicate with payors and other stakeholders to resolve issues and ensure timely reimbursement.
  • Participate in quality improvement initiatives to enhance the overall quality of care and patient satisfaction.
Requirements:
  • Current RN licensure in New York State.
  • Bachelor's degree in Nursing or related field.
  • Minimum of three years of clinical experience in an acute care setting.
  • Recent experience in case management, utilization management, and/or discharge planning preferred.
  • Assertive and creative problem-solving skills, with the ability to work independently and as part of a team.
  • Excellent written and verbal communication skills, with the ability to effectively communicate with patients, families, and healthcare professionals.

Albany Medical Center is an equal opportunity employer and welcomes applications from diverse candidates. If you are a motivated and compassionate healthcare professional looking to make a difference in the lives of our patients, we encourage you to apply for this exciting opportunity.



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