Join Albany Medical Center as a Utilization Review Nurse, responsible for monitoring patient care quality and resource use. Leverage your clinical expertise and critical thinking skills to enhance patient outcomes in a fast-paced healthcare environment.
Key Responsibilities
Completes Utilization Management and Quality Screening for assigned patients
Monitors appropriateness of admissions and continued stays based on MCG criteria
Identifies areas for clinical documentation improvement
Monitors length of stay and ancillary resource use
Communicates covered day reimbursement certification for assigned patients
Collaborates with healthcare team for care management
Required Qualifications
Registered nurse with a New York State current license
Minimum of three years clinical experience in an assigned service
Basic knowledge of computer systems applicable to utilization review
Excellent written and verbal communication skills
Strong analytic, data management and PC skills
Preferred Qualifications
Bachelor's degree
Recent experience in case management, utilization management and/or discharge planning/home care in a high volume acute care hospital
PRI and Case Management certification
Working knowledge of MCG criteria
Understanding of Inpatient versus Outpatient surgery and ICD10-Coding
Ability to work independently and demonstrate organizational and time management skills
Working knowledge of Medicare regulatory requirements and Managed Care Plans