Utilization Review Nurse Specialist
2 weeks ago
We are seeking a skilled Utilization Review Nurse to join our team at Albany Medical Center. 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.
Key Responsibilities- Conduct thorough utilization reviews to identify opportunities for improvement in patient care and resource utilization.
- Collaborate with healthcare teams to develop and implement effective care plans that meet the needs of patients and reduce unnecessary costs.
- Utilize MCG criteria to monitor appropriateness of admissions and continued stays, and document findings based on departmental standards.
- Identify areas for clinical documentation improvement and work with clinical staff to implement changes.
- Monitor length of stay (LOS) and ancillary resource use, taking actions to achieve continuous improvement in both areas.
- Communicate with payors and resolve issues on a case-by-case basis.
- Use quality screens to identify potential issues and forward information to the Quality Department.
- Facilitate removal of delays and document delays when they exist.
- 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.
- Assertive and creative problem-solving skills, critical thinking, 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.
Albany Medical Center is an equal opportunity employer. This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners. Workforce members are expected to ensure that access to information is based on a 'need to know' and is the minimum necessary to properly perform assigned duties.
-
Clinical Utilization Review Specialist
4 weeks ago
Averill Park, New York, United States Albany Medical Center Full timeJob SummaryAlbany Medical Center is seeking a skilled Clinical Utilization Review Specialist to join our team. As a key member of our Care Management department, you will be responsible for ensuring the efficient and effective use of healthcare resources.Key ResponsibilitiesConduct thorough reviews of patient records to identify opportunities for improvement...
-
Clinical Utilization Review Specialist
4 weeks ago
Averill Park, New York, United States Albany Medical Center Full timeJob SummaryAlbany Medical Center is seeking a skilled Clinical Utilization Review Specialist to join our team. As a key member of our Care Management department, you will play a critical role in ensuring the quality and efficiency of patient care.Key ResponsibilitiesConduct thorough utilization reviews to identify opportunities for improvement in patient...
-
Clinical Utilization Review Specialist
3 weeks ago
Averill Park, New York, United States Albany Medical Center Full timeJob SummaryWe are seeking a highly skilled Clinical Utilization Review Specialist to join our team at Albany Medical Center. As a key member of our Care Management department, you will play a critical role in ensuring the quality and efficiency of patient care.Key ResponsibilitiesConduct thorough utilization reviews to identify opportunities for improvement...
-
Utilization Review Nurse Specialist
2 weeks ago
Averill Park, New York, United States Albany Medical Center Full timeJob SummaryWe are seeking a skilled Utilization Review Nurse to join our team at Albany Medical Center. 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.Key ResponsibilitiesConduct thorough utilization reviews to identify opportunities for improvement in...
-
Clinical Utilization Review Specialist
3 weeks ago
Averill Park, New York, United States Albany Medical Center Full timeJob SummaryWe are seeking a skilled Utilization Review Nurse to join our Care Management team at Albany Medical Center. As a key member of our team, you will be responsible for ensuring the efficient and effective use of healthcare resources while maintaining high-quality patient care.Key ResponsibilitiesConduct thorough utilization reviews to identify...
-
Clinical Utilization Specialist
3 weeks ago
Averill Park, New York, United States Albany Medical Center Full time{"title": "Clinical Utilization Specialist", "content": "Job SummaryAlbany Medical Center seeks a skilled Clinical Utilization Specialist to join our Care Management team. In this role, you will be responsible for ensuring the efficient and effective use of healthcare resources while maintaining high-quality patient care.Key ResponsibilitiesConduct thorough...
-
Clinical Utilization Nurse Specialist
2 days ago
Averill Park, New York, United States Albany Medical Center Full timeJob SummaryWe are seeking a skilled Clinical Utilization Nurse to join our team at Albany Medical Center. As a key member of our Care Management department, you will play a critical role in ensuring the highest quality patient care and outcomes.ResponsibilitiesConduct thorough utilization reviews to ensure medical necessity and appropriateness of patient...
-
Nurse Utilization Review Specialist
3 weeks ago
Cliffside Park, New Jersey, United States VNS Health Full timeJob Title: Registered Nurse - Utilization ReviewVNS Health is seeking a skilled Registered Nurse to join our team as a Utilization Review Specialist. In this role, you will play a critical part in ensuring the highest quality of care for our patients.Job Summary:The Utilization Review Specialist will be responsible for conducting clinical assessments,...
-
Nurse Utilization Review Specialist
4 weeks ago
Cliffside Park, New Jersey, United States VNS Health Full timeAbout the RoleVNS Health is seeking a skilled Nurse Utilization Review Specialist to join our team. As a key member of our quality improvement team, you will play a critical role in ensuring the highest level of patient care and satisfaction.Key ResponsibilitiesConduct clinical assessments, including medication reconciliations, post-discharge transitions of...
-
Utilization Review Nurse
3 days ago
Clifton Park, New York, United States Albany Medical Center Full timeJob Title: Utilization Review NurseAlbany 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 meet medical necessity and are in compliance with regulatory requirements.Key Responsibilities:Conduct thorough...
-
Registered Nurse Utilization Review Specialist
3 weeks ago
Cliffside Park, New Jersey, United States VNS Health Full timeJob Title: Registered Nurse Utilization Review SpecialistVNS Health is seeking a highly skilled Registered Nurse to join our team as a Utilization Review Specialist. As a key member of our quality improvement team, you will play a critical role in ensuring the highest level of patient care and satisfaction.Responsibilities:Conduct clinical assessments,...
-
Nurse Utilization Review Specialist
3 weeks ago
Cliffside Park, New Jersey, United States VNS Health Full timeAbout the RoleVNS Health is seeking a skilled Registered Nurse to join our team as a Utilization Review Specialist. In this role, you will play a critical part in ensuring the highest quality of care for our patients.Key ResponsibilitiesConduct thorough clinical assessments, including medication reconciliations and post-discharge transitions of...
-
Clinical Utilization Review Specialist
2 weeks ago
Cliffside Park, New Jersey, United States VNS Health Full timeJob Description:As a Clinical Utilization Review Specialist at VNS Health, you will play a critical role in ensuring the accuracy and compliance of grievances, appeals, and external reviews for our Managed Long Term Care (MLTC), Medicare Advantage (MA), and Select Health product lines.Key Responsibilities:Review and analyze grievances, appeals, and external...
-
Utilization Review Nurse
3 weeks ago
Clifton Park, New York, United States Albany Medical Center Full timeJob SummaryWe are seeking a highly skilled Utilization Review Nurse to join our team at Albany Medical Center. As a key member of our Care Management department, you will be responsible for ensuring the efficient and effective use of healthcare resources.Key ResponsibilitiesConduct thorough utilization reviews to identify opportunities for improvement in...
-
Clinical Utilization Specialist
2 weeks ago
Clifton Park, New York, United States Albany Medical Center Full timeJob SummaryWe are seeking a skilled Clinical Utilization Specialist to join our team at Albany Medical Center. As a key member of our Care Management department, you will play a critical role in ensuring the efficient and effective delivery of patient care.Key ResponsibilitiesConduct thorough utilization reviews to identify opportunities for improvement in...
-
Clinical Utilization Nurse Specialist
1 week ago
Clifton Park, New York, United States Albany Medical Center Full timeJob SummaryWe are seeking a skilled Clinical Utilization Nurse to join our team at Albany Medical Center. As a key member of our Care Management department, you will play a critical role in ensuring the quality and appropriateness of patient care.Key ResponsibilitiesReview and manage patient utilization and quality of care to ensure alignment with...
-
Maternal Nurse Reviewer
3 weeks ago
New Hyde Park, New York, United States GreenLife Healthcare Staffing Full timeJob Title: Maternal Nurse ReviewerWe are seeking a skilled Maternal Nurse Reviewer to join our team at Greenlife Healthcare Staffing. As a Maternal Nurse Reviewer, you will be responsible for conducting clinical reviews of medical records and providing technical assistance to program personnel.Responsibilities:Conduct clinical reviews of medical records from...
-
Clinical Reviewer
4 days ago
New Hyde Park, New York, United States IPRO Full timeClinical Reviewer Job DescriptionAs a Clinical Reviewer at IPRO, you will play a crucial role in ensuring the accuracy and appropriateness of healthcare services. Your expertise will be utilized to conduct clinical-level reviews, supporting Medical Review Analysts and Physician Consultants in their decision-making processes.Key Responsibilities:Conduct...
-
Averill Park, New York, United States Albany Medical Center Full timeJob SummaryWe are seeking a skilled Clinical Nurse II to join our Emergency Department team at Albany Medical Center. As a key member of our team, you will contribute to the creation of a compassionate and caring environment for patients, families, and colleagues.Key Responsibilities:Provide high-quality patient care in a fast-paced emergency department...
-
Averill Park, New York, United States Albany Medical Center Full timeJob SummaryWe are seeking a skilled Clinical Nurse II to join our Emergency Department team at Albany Medical Center. As a key member of our team, you will contribute to the creation of a compassionate and caring environment for patients, families, and colleagues.Key Responsibilities:Provide high-quality patient care in a fast-paced emergency department...
