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Utilization Review Nurse Specialist
2 months ago
We are seeking a skilled Utilization Review Nurse to join our team at Albany Medical Center. As a Utilization Review Nurse, you will play a critical role in ensuring the efficient and effective use of healthcare resources.
Key Responsibilities- Conduct thorough reviews of patient cases to determine medical necessity and appropriateness of care
- Apply MCG criteria to monitor and improve the quality of care
- Collaborate with healthcare teams to identify areas for clinical documentation improvement
- Identify at-risk populations and develop strategies to improve outcomes
- Monitor length of stay and ancillary resource use to optimize resource allocation
- Communicate with payors and healthcare teams to resolve issues and improve care coordination
- 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 and offers a competitive salary and benefits package.
