Utilization Review Nurse

5 days ago

Averill Park, 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.
  • Collaborate with healthcare teams to develop and implement plans to optimize patient care and reduce costs.
  • Communicate with payors and other stakeholders to resolve issues and ensure seamless care transitions.
  • Monitor and analyze data to identify trends and opportunities for improvement in care and resource utilization.
  • Develop and maintain relationships with healthcare providers and payors 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.
  • Assertive and creative in problem solving, critical thinking skills, 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
What We Offer:
  • A competitive salary and benefits package.
  • A dynamic and supportive work environment.
  • Opportunities for professional growth and development.

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