Nurse for Utilization Review

Are you a dedicated registered nurse with a passion for ensuring optimal patient care? Join us in Delanson, NY, in the Care Management/Social Work department as a Utilization Review Nurse! We are looking for a dynamic professional who can drive quality improvement and streamline care management for our patients.

In this role, you will be responsible for:

Conducting Utilization Management and Quality Screening for assigned patients while applying MCG criteria to evaluate admissions and continued stays.

Identifying opportunities for clinical documentation improvement and collaborating with the appropriate departments.

Monitoring Length of Stay (LOS) and ancillary resource use steadily, implementing actions to achieve ongoing improvements.

Communicating reimbursement certifications and addressing case-by-case payor issues with clinical staff.

Utilizing quality screens to recognize potential issues and forwarding this information to the Quality Department.

Documenting and facilitating the removal of delays while reporting to the Triad Team.

Collaborating efficiently with health care teams to ensure seamless care management across the continuum.

Minimum Qualifications:

Current Registered Nurse license in New York State.

Bachelor's degree preferred.

A minimum of three years of clinical experience in a relevant service.

Preferred experience in case management, utilization management, or discharge planning within a high-volume acute care setting.

Case Management certification or PRI experience is a plus.

Proven problem-solving, critical thinking, and organizational skills.

Proficiency in computer systems relevant to utilization review processes.

Excellent communication abilities, both written and verbal.

Familiarity with MCG criteria and regulatory requirements regarding Medicare and Managed Care Plans.

This position plays a vital role in our mission to provide exceptional patient care and improve patient outcomes. We encourage qualified candidates to apply and be part of our dedicated team!

Thank you for considering a career with Albany Medical Center, an equal opportunity employer.

Note: This role may require access to sensitive information, including HIPAA Protected Health Information. All workforce members must adhere to our policies regarding information access and confidentiality.