Utilization Review Nurse
1 week ago
Albany Medical Center is seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will be responsible for reviewing patient admissions and continued stays to ensure that they are medically necessary and meet departmental standards. You will also be responsible for identifying areas for clinical documentation improvement and communicating with the healthcare team to ensure that patients receive the best possible care.
Responsibilities:
- Reviews patient admissions and continued stays to ensure that they are medically necessary and meet departmental standards.
- Identifies areas for clinical documentation improvement and communicates with the healthcare team to ensure that patients receive the best possible care.
- Collaborates with the healthcare team to ensure that patients receive comprehensive care across the continuum of care.
- Communicates with payors to resolve issues and ensure that patients receive the best possible care.
- Identifies and reports internal and external delays to the Triad Team.
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.
- Assertive and creative in problem solving, critical thinking skills, systems planning and patient care management.
- Self-directed with the ability to adapt in a changing environment.
- Basic knowledge of computer systems with skills applicable to utilization review process.
- Excellent written and verbal communication skills.
- Working knowledge of MCG criteria and ability to implement and utilize.
- Understanding of Inpatient versus Outpatient surgery and ICD10-Coding (preferred) and Observation status qualifications.
- Ability to work independently and demonstrate organizational and time management skills.
- Strong analytic, data management and PC skills.
- Working knowledge of Medicare regulatory requirements, Managed Care Plans
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