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Job Summary
We are seeking a skilled Utilization Review Nurse to join our team at Albany Medical Center. As a key member of our Care Management/Social Work department, you will play a critical role in ensuring the efficient and effective delivery of patient care.
Key Responsibilities- Conduct thorough utilization reviews to identify opportunities for improvement in patient care and resource utilization.
- Apply MCG criteria to monitor the appropriateness of admissions and continued stays, and document findings in accordance with departmental standards.
- Collaborate with healthcare teams to identify areas for clinical documentation improvement and implement changes as needed.
- Utilize approved screening tools to identify at-risk populations and develop strategies for improvement.
- Monitor length of stay (LOS) and ancillary resource use, taking proactive steps to achieve continuous improvement.
- Communicate with payors to resolve issues and ensure timely reimbursement.
- Facilitate the removal of delays and document delays when they exist.
- 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.
- Case Management certification preferred.
Albany Medical Center is an equal opportunity employer committed to providing a work environment that is free from discrimination and harassment. We are dedicated to fostering a culture of diversity, equity, and inclusion, and we welcome applications from qualified candidates from diverse backgrounds.
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