Clinical Utilization Review Specialist

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.

• 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, reporting to the Triad Team as needed.

• 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.
• Assertive and creative problem-solving skills, with the ability to adapt in a changing environment.
• Basic knowledge of computer systems and skills applicable to utilization review process.
• Excellent written and verbal communication skills.
• Working knowledge of MCG criteria and ability to implement and utilize.

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.