Utilization Review Nurse Specialist

3 weeks ago


Altamont, New York, United States Albany Medical Center Full time
Job Summary

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
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
  • Case Management certification preferred
About Albany Medical Center

Albany Medical Center is a leading healthcare provider in the Capital Region, dedicated to delivering high-quality patient care and advancing medical research and education.



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