Clinical Utilization Review Specialist

We are seeking a skilled Utilization Review Nurse to join our Care Management team at Albany Medical Center. As a key member of our team, you will be responsible for ensuring the efficient and effective use of healthcare resources while maintaining high-quality patient care.

• Conduct thorough utilization reviews to identify opportunities for improvement in patient care and resource utilization.
• Collaborate with healthcare teams to develop and implement effective care plans that meet the needs of patients and reduce unnecessary costs.
• Apply MCG criteria to monitor the appropriateness of admissions and continued stays, and document findings according to departmental standards.
• Identify areas for clinical documentation improvement and work with the quality department to implement changes.
• Monitor length of stay and ancillary resource use, taking actions to achieve continuous improvement in both areas.
• Communicate with payors and clinical staff to resolve issues and ensure seamless care transitions.

• 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.