Join Albany Medical Center as a Utilization Review Nurse where you will play a pivotal role in managing patient care through Utilization Management and Quality Screening. Utilize your nursing expertise to enhance clinical documentation, engage with healthcare teams, and ensure optimal resource utilization for patients.
Key Responsibilities
Conduct Utilization Management and Quality Screening for assigned patients
Apply MCG criteria to monitor appropriateness of admissions and continued stays
Identify areas for clinical documentation improvement
Monitor Length of Stay and ancillary resource use
Communicate covered day reimbursement certification for assigned patients
Collaborate with the health care 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 process
Excellent written and verbal communication skills
Strong analytic, data management and PC skills
Working knowledge of Medicare regulatory requirements and Managed Care Plans
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 vs Outpatient surgery and ICD10-Coding
Ability to work independently and demonstrate organizational and time management skills