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, reducing unnecessary hospital stays and resource utilization.
  • Collaborate with healthcare teams to identify areas for clinical documentation improvement and implement changes to optimize patient outcomes.
  • Identify at-risk populations and develop strategies to improve care coordination and reduce hospital readmissions.
  • Monitor length of stay (LOS) and ancillary resource use, taking proactive steps to achieve continuous improvement.
  • Communicate with payors and healthcare teams to resolve issues and ensure seamless care transitions.
  • Utilize quality screens to identify potential issues and report to the Quality Department.
  • Facilitate removal of delays and document delays when they exist, reporting 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 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, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes.

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. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.



  • Altamont, New York, United States Albany Medical Center Full time

    Job Title: Utilization Review NurseAlbany Medical Center is seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring that patients receive the most appropriate care while minimizing unnecessary costs.Key Responsibilities:Conduct thorough reviews of patient records to identify areas...


  • Altamont, New York, United States Albany Medical Center Full time

    Job 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 reviews of patient records to identify opportunities for improvement in...


  • Altamont, New York, United States Albany Medical Center Full time

    Job SummaryWe 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 ResponsibilitiesConduct thorough reviews of patient cases to determine medical necessity and appropriateness of careApply...


  • Altamont, New York, United States Albany Medical Center Full time

    Job SummaryWe are seeking a skilled Utilization Review Nurse to join our team at Albany Medical Center. As a key member of our Care Management/Social Work department, you will play a critical role in ensuring the quality and appropriateness of patient care.Key ResponsibilitiesConduct thorough utilization reviews to identify areas for improvement and optimize...


  • Altamont, New York, United States Albany Medical Center Full time

    Job SummaryWe are seeking a highly skilled Nurse Practitioner to join our team at Albany Medical Center. The successful candidate will be responsible for providing high-quality patient care, working collaboratively with our healthcare team, and contributing to the development of our surgical care services.Key ResponsibilitiesConduct comprehensive patient...

  • Nurse Practitioner

    3 weeks ago


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

    Job SummaryWe are seeking a highly skilled and compassionate Nurse to join our team at Albany Medical Center. As a Graduate Nurse, you will have the opportunity to work in a dynamic and supportive environment, providing exceptional patient care and contributing to the delivery of high-quality healthcare services.Key ResponsibilitiesAssess and evaluate...

  • Nurse Practitioner

    3 weeks ago


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

    Job SummaryWe are seeking a highly skilled and compassionate Nurse to join our team at Albany Medical Center. As a Graduate Nurse, you will have the opportunity to work in a dynamic and supportive environment, providing exceptional patient care and contributing to the delivery of high-quality healthcare services.Key ResponsibilitiesAssess and evaluate...

  • Nurse Practitioner

    3 weeks ago


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

    Job SummaryWe are seeking a highly skilled and compassionate Nurse to join our team at Albany Medical Center. As a Graduate Nurse, you will have the opportunity to work in a dynamic and supportive environment, providing exceptional patient care and contributing to the delivery of high-quality healthcare services.Key ResponsibilitiesAssess and evaluate...

  • Nurse Practitioner

    3 weeks ago


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

    Job SummaryWe are seeking a highly skilled and compassionate Nurse to join our team at Albany Medical Center. As a Graduate Nurse, you will have the opportunity to work in a dynamic and supportive environment, providing exceptional patient care and contributing to the delivery of high-quality healthcare services.Key ResponsibilitiesAssess and Evaluate...


  • Altamont, New York, United States Albany Medical Center Full time

    Pulmonary, Renal and General Medical Unit Registered NurseAlbany Medical Center is seeking a skilled Registered Nurse to join our Pulmonary, Renal and General Medical Unit. As a Registered Nurse on this unit, you will provide high-quality patient care to a diverse population of male and female patients with a variety of medical/surgical diagnoses.Key...


  • Altamont, New York, United States Albany Medical Center Full time

    Pulmonary, Renal and General Medical Unit Registered NurseAlbany Medical Center is seeking a skilled Registered Nurse to join our Pulmonary, Renal and General Medical Unit. As a Registered Nurse on this unit, you will provide high-quality patient care to a diverse population of male and female patients with a variety of medical/surgical diagnoses.Key...


  • Altamont, New York, United States Albany Medical Center Full time

    Pulmonary, Renal and General Medical Unit Registered NurseAlbany Medical Center is seeking a skilled Registered Nurse to join our Pulmonary, Renal and General Medical Unit. As a Registered Nurse on this unit, you will provide high-quality patient care to a diverse population of male and female patients with a variety of medical/surgical diagnoses.Key...


  • Altamont, New York, United States Hueman Risk Adjustment Full time

    Job OpportunityHueman Risk Adjustment is seeking skilled Nurse Practitioners and Physician Assistants to conduct in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in the Altamont, NY area.This unique opportunity offers a flexible schedule, allowing you to balance your professional goals with your personal life. As a member of our team,...


  • Altamont, New York, United States Hueman Risk Adjustment Solutions Full time

    Join Our Team of Healthcare ProfessionalsHueman Risk Adjustment Solutions is actively seeking skilled Nurse Practitioners and Physician Assistants to join our team of healthcare professionals. As a member of our team, you will have the opportunity to work in a unique and rewarding environment, conducting in-home Health Risk Assessments (HRAs) for Medicare...


  • altamont, United States Albany Medical Center Full time

    Altamont, NY, United States Department/Unit: Care Management/Social WorkWork Shift: Day (United States of America)Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients.Salary: $65,062.40 -$107,348.80• Completes Utilization Management and Quality Screening for assigned patients. • Applies MCG criteria to...


  • Altamont, United States ProCare Therapy Full time

    Job DescriptionJob DescriptionMinimum 1+ years Deaf & Hard of Hearing Specialist experience required.We are looking for a dedicated and qualified school professional to work as a DHH teacher in theAltamont, NY area for the remainder of this school year. The right candidate will have a possible opportunity of renewing for next year. See details...


  • Altamont, United States PrimeSource Building Products Full time

    Job DescriptionCustomer Service Representative Job Description PrimeSource Building Products Inc., one of the nation's largest wholesale distributors of building supply products, has an immediate opportunity for a Customer Service Specialist, in support for PrimeSource's Inside Sales Department. This Customer Service Specialist role will provide the admin...


  • Altamont, Tennessee, United States Grundy County Board of Education Full time

    Job OverviewPosition Title: Educational AssistantRequired Qualifications:Completion of High School or equivalent certificationFurther education such as an Associate's Degree, 48 semester hours of higher education, or a state-recognized equivalency assessmentAt least one year of pertinent experience in an educational settingObjective: To support educators,...


  • Altamont, United States Britt Medical Search LLC Defunct Full time

    DocCafe has an immediate opening for the following position: Dermatology Nurse Practitioner in Altamont, New York. DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career. Register now to apply for this job and for access to 125,000+ other openings. DocCafe Offers: Free Physician and Advanced Practice Job...


  • Altamont, United States Britt Medical Search LLC Defunct Full time

    DocCafe has an immediate opening for the following position: Allergy/Immunology Nurse Practitioner in Altamont, New York. DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career. Register now to apply for this job and for access to 125,000+ other openings. DocCafe Offers: Free Physician and Advanced...

  • RN Weekend Baylor

    2 weeks ago


    Altamont, United States The Grand Rehabilitation & Nursing Full time

    $7,500.00 RN Sign-On Bonus (for full-time) The Grand Story: Combining beautiful residences with modern amenities, The Grand Healthcare System provides a range of accommodations that go above and beyond your expectations. Our soft linens and cozy furnishings are just a small part of what makes our unique all-inclusive health facilities a preferred...


  • Altamont, United States Hueman Risk Adjustment Solutions Full time

    Description Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Altamont, NY. This unique opportunity adapts to your lifestyle, giving you the freedom to achieve your professional goals on your terms, all while enjoying a schedule designed...

  • RN Unit Manager

    4 months ago


    Altamont, United States The Grand Rehabilitation & Nursing Full time

    $7,500.00 RN Sign-On Bonus! The Grand Story: Combining beautiful residences with modern amenities, The Grand Healthcare System provides a range of accommodations that go above and beyond your expectations. Our soft linens and cozy furnishings are just a small part of what makes our unique all-inclusive health facilities a preferred destination for high...

  • MDS Coordinator

    2 months ago


    Altamont, United States The Grand Rehabilitation & Nursing Full time

    The Grand Story: Combining beautiful residences with modern amenities, The Grand Healthcare System provides a range of accommodations that go above and beyond your expectations. Our soft linens and cozy furnishings are just a small part of what makes our unique all-inclusive health facilities a preferred destination for high quality healthcare. The Grand...


  • Altamont, Tennessee, United States Grundy County Board of Education Full time

    Job OverviewPosition Title: Educational AssistantRequired Qualifications:Completion of High School or equivalent certificationAdditional educational credentials such as an Associate's Degree, 48 semester hours of post-secondary education, or state-required equivalency assessmentAt least one year of pertinent experience in an educational settingObjective: To...


  • Altamont, NY, United States Britt Medical Search Full time

    DocCafe has an immediate opening for the following position: Dermatology Nurse Practitioner in Altamont, New York. DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career. Register now to apply for this job and for access to 125,000+ other openings. DocCafe Offers: Free Physician and Advanced Practice Job...


  • Altamont, NY, United States Britt Medical Search Full time

    DocCafe has an immediate opening for the following position: Dermatology Nurse Practitioner in Altamont, New York. DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career. Register now to apply for this job and for access to 125,000+ other openings. DocCafe Offers: Free Physician and Advanced Practice Job...


  • Altamont, NY, United States Britt Medical Search Full time

    DocCafe has an immediate opening for the following position: Allergy/Immunology Nurse Practitioner in Altamont, New York. DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career. Register now to apply for this job and for access to 125,000+ other openings. DocCafe Offers: Free Physician and Advanced...