Utilization Review Nurse Specialist

1 week ago

Albany, New York, United States Albany Medical Center Full time
Job Title: Utilization Review Nurse

Albany 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 for improvement in care and resource utilization.
  • Apply MCG criteria to assess the appropriateness of admissions and continued stays, and document findings according to departmental standards.
  • Identify at-risk populations using approved screening tools and report findings to the Quality Department.
  • Collaborate with the healthcare team to develop and implement plans to improve patient outcomes and reduce costs.
  • Communicate with payors and other stakeholders to resolve issues and ensure seamless care transitions.
  • Stay up-to-date with changing regulations and guidelines to ensure compliance and optimal care delivery.
Requirements:
  • Current RN licensure in New York State.
  • Bachelor's degree in Nursing or related field.
  • Minimum 3 years of clinical experience in an acute care setting.
  • Experience in case management, utilization management, and/or discharge planning preferred.
  • Strong analytical and problem-solving skills, with ability to work independently and as part of a team.
  • Excellent communication and interpersonal skills, with ability to work effectively with diverse stakeholders.

Albany Medical Center is an equal opportunity employer and welcomes applications from diverse candidates. This role may require access to sensitive information, and applicants must be able to maintain confidentiality and adhere to HIPAA guidelines.

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