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Clinical Utilization Review Specialist

2 months ago

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

We 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 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 patient needs and optimize resource use.
  • Communicate with payors and other stakeholders to resolve issues and ensure seamless care transitions.
  • Monitor and analyze data to identify trends and areas for improvement in care management and resource utilization.
  • Develop and maintain strong relationships with healthcare teams, payors, and other stakeholders to ensure effective communication and collaboration.
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.
What We Offer

Albany Medical Center is an equal opportunity employer and offers a competitive salary and benefits package. If you are a motivated and detail-oriented individual with a passion for patient care and resource management, we encourage you to apply for this exciting opportunity.