Clinical Utilization Review Specialist

  • Schenectady
  • Albany Medical Center
Job Summary

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.

Key Responsibilities
  • 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 families.
  • Communicate with payors and other stakeholders to resolve issues and ensure timely reimbursement.
  • Monitor and analyze data to identify trends and areas for improvement in patient care and resource utilization.
  • Develop and maintain relationships with healthcare providers and payors to ensure seamless care transitions and optimal resource utilization.
Requirements
  • Registered Nurse with a current New York State license.
  • Minimum of three years of clinical experience in an acute care setting.
  • Recent experience in case management, utilization management, and/or discharge planning/home care preferred.
  • Case Management certification preferred.
  • Excellent communication and interpersonal skills.
  • Ability to work independently and as part of a team.
  • Strong analytical and problem-solving skills.
What We Offer

Albany Medical Center is an equal opportunity employer and offers a competitive salary and benefits package. If you are a motivated and detail-oriented individual who is passionate about delivering high-quality patient care, we encourage you to apply for this exciting opportunity.