Utilization Review Nurse
$77.08k - $119.47kAlbany Medical College
- # Utilization Review NurseApplylocations: 43 New Scotland Avenue Albany, NY 12208time type: Full timeposted on: Posted Todayjob requisition id: 71163Department/Unit:Care Management/Social WorkWork Shift:Day (United States of America)Salary Range:$77,075.00 - $119,466.00Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients.• Completes Utilization Management and Quality Screening for assigned patients. • Applies MCG criteria to monitor appropriateness of admissions and continued stays, and documents findings based on Departmental standards. • While performing utilization review identifies areas for clinical documentation improvement and contacts appropriate department. • Identifies at-risk populations using approved screening tool and follows established reporting procedures. • Monitors LOS and ancillary resource use on an ongoing basis. Takes actions to achieve continuous improvement in both areas. • Refers cases and issues to Medical Director and Triad Team in compliance with Department procedures and follows up as indicated. • Communicates covered day reimbursement certification for assigned patients. • Discusses payor criteria and issues and a case-by-case basis with clinical staff and follows up to resolve problems with payors as needed. • Uses quality screens to identify potential issues and forwards information to the Quality Department. • Demonstrates proper use of MCG and documentation requirements through case review and inter-rater reliability studies. • Facilitates removal of delays and documents delays when they exist. Reports internal and external delays to the Triad Team. • Collaborates with the health care team and appropriate department in the management of care across the continuum of care by assuring communication with Triad Team and health care team.**Minimum Qualifications:** • Registered nurse with a New York State current license. • Associate's degree required. 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. PRI and • Case Management certification preferred. • Assertive and creative in problem solving, critical thinking skills, systems planning and patient care management. • Self-directed with the ability to adapt in a changing environment. • Basic knowledge of computer systems with skills applicable to utilization review process. • Excellent written and verbal communication skills. • Working knowledge of MCG criteria and ability to implement and utilize. • Understanding of Inpatient versus Outpatient surgery and ICD10-Coding (preferred) and Observation status qualifications. • Ability to work independently and demonstrate organizational and time management skills. • Strong analytic, data management and PC skills. • Working knowledge of Medicare regulatory requirements, Managed Care PlansThank you for your interest in Albany Med Health System!Albany Med Health System is an equal opportunity employer.This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.
- J-18808-Ljbffr Albany Medical College
Vacancy posted 5 days ago
Similar jobs that could be interesting for youBased on the Utilization Review Nurse in Albany, NY vacancy
$77.08k - $119.47k
...,075.00 - $119,466.00 Responsible for Utilization Management, Quality Screening and Delay... ...standards.• While performing utilization review identifies areas for clinical documentation... ...Minimum Qualifications:• Registered nurse with a New York State current license.•...SuggestedFull timeShift workAlbany Medical Center
Albany, NY1 day ago$84.78k - $131.41k
...84,783.00 - $131,414.00 Responsible for Utilization Management, Quality Screening and Delay Management... .../Trauma Care and/or previous Utilization Review roles. Qualifications and Ideal Characteristics Registered nurse with a New York State current license....SuggestedShift workAlbany Med
Albany, NY5 days ago- ...Job Description Welcome to Albany Gastroenterology Consultants! We are seeking a Registered Nurse (RN)must have the following qualifications and Infusion Registered Nurse (RN) to join our team. \n \n \n Albany Gastroenterology Consultants has partnered with Allied...SuggestedDaily paid
Allied Digestive Health
Albany, NY26 days ago $3,500 per month
...Opportunity Employer. Valid NYS RN license. Previous experience in an RN role. Strong computer skills. Knowledge of basic nursing principles and protocols. Knowledge of medical chart reporting/records. Skill in appropriate assessment and assistance...SuggestedHourly payFull timeWork experience placementCasual workWork at officeMonday to FridayCommunity Care Physicians
Glenmont, NY10 hours ago- ...n Preferred experience: \n \n \n ~ Infusions \n \n \n IV certification \n Provides patient care based on Infusion Nurses Society guidelines, standards of care, and federal and state laws and regulations along with Allied Digestive Health policies and procedures...SuggestedFull timeRelocation package
Allied Digestive Health
Albany, NY19 days ago $2,468 per week
...Health Advocates Network is urgently hiring PICU Registered Nurses (RNs) in the Albany, NY area. Must have 2 years PICU experience. ~ Pay Rate: $2,468 weekly ~ Specialty: PICU Registered Nurse (RN) ~ Shift: Day ~13 Week Contracts and more available! Qualification...Weekly payDaily paidTemporary workImmediate startShift workHealth Advocates Network, Inc.
Albany, NY10 hours ago$2,593 per week
...Health Advocates Network is urgently hiring PICU Registered Nurses (RNs) in the Albany, NY area. Must have 2 years PICU experience. ~ Pay Rate: $2,593 weekly ~ Specialty: PICU Registered Nurse (RN) ~ Shift: Night ~13 Week Contracts and more available...Weekly payDaily paidTemporary workImmediate startShift workNight shiftHealth Advocates Network, Inc.
Albany, NY10 hours ago$2,968 per week
...Health Advocates Network is urgently hiring L & D Registered Nurses (RNs) in the Albany, NY area. Must have 2 years L & D experience. ~ Pay Rate: $2,968 weekly ~ Specialty: L & D Registered Nurse (RN) ~ Shift: Day ~13 Week Contracts and more available! Qualification...Weekly payDaily paidTemporary workImmediate startShift workHealth Advocates Network, Inc.
Albany, NY10 hours ago$2,718 per week
...Health Advocates Network is urgently hiring ICU Registered Nurses (RNs) in the Albany, NY area. Must have 2 years ICU experience. ~ Pay Rate: $2,718 weekly ~ Specialty: ICU Registered Nurse (RN) ~ Shift: Night ~13 Week Contracts and more available...Weekly payDaily paidTemporary workImmediate startShift workNight shiftHealth Advocates Network, Inc.
Albany, NY10 hours ago$3,500 per month
...experience as a Medical Assistant or Patient Care Tech. Strong computer skills with experience using EMR. Knowledge of basic nursing principles and protocols. Knowledge of policies and procedures related to infection control, environmental safety, and patient confidentiality...Hourly payWork experience placementCasual workWork at officeMonday to FridayFlexible hoursWeekend workCommunity Care Physicians
Newtonville, NY10 hours ago- Allied Digestive Health is seeking a Per Diem Infusion RN to deliver safe, high-quality infusion therapy in our GI-focused outpatient centers. In this role, you will start and manage IVs, administer biologics and other infusions, monitor patients for adverse reactions, ...Daily paidFlexible hours
Allied Digestive Health
Albany, NY1 day ago $80 per hour
Job Description Job Description Set your own schedule. Low-stress clinical work. New grads welcome. We're hiring 1099 NPs to complete pre-scheduled, in-home health assessments for Medicare Advantage, Medicaid, and commercial health plan members. Pre-populated forms...Long term contractTemporary workWeekend workNortheast Healthcare Recruitment
Albany, NYa month ago$2,700 per month
...Details Client Name Albany Medical Center Hospital Job Type Travel Offering Nursing Profession RN Specialty CVOR Job ID 15831699 Weekly Pay $2700.0 Shift Details Shift 07:00 AM...Hourly payWeekly payShift workWynn Hospital
Albany, NY4 days ago$2,781 per month
...Details Client Name Albany Medical Center Job Type Travel Offering Nursing Profession RN Specialty CVOR Job ID 19057876 Weekly Pay $2781.0 Shift Details Shift 4x10 Days Scheduled...Weekly payShift workAlbany Medical Center
Albany, NY4 days ago- ...Pediatric Cardiac ICU Nurse This position requires working the night shift from 7 PM to 7:30 AM. We are seeking a dedicated and... ...effective nursing care to pediatric patients in the Cardiac ICU. Utilize Epic systems for documentation and patient management....Contract workLocal areaNight shift
Albany Medical Center Hospital
Albany, NY4 days ago $2,968 per week
...Health Advocates Network is urgently hiring L & D Registered Nurses (RNs) in the Albany, NY area. Must have 2 years L & D experience. ~ Pay Rate: $2,968 weekly ~ Specialty: L & D Registered Nurse (RN) ~ Shift: Day ~13 Week Contracts and more available! Qualification...Weekly payDaily paidTemporary workLocal areaImmediate startShift workHealth Advocates Network
Albany, NY3 days ago$2,190 - $2,330 per week
...ARC) certification Other certifications and licenses may be required for this position Summary: The Med Surg/Tele Registered Nurse delivers comprehensive high-quality, patient-centered care in medical-surgical and telemetry units. This role involves assessing...Temporary workShift workFusion Medical Staffing
Albany, NY3 days ago- Benefits We Offer: Comprehensive health, prescription, dental, vision, life, and disability plans Competitive pay rates Referral opportunities ? Refer a friend & Cash in! Travel reimbursement and per diem allowances Employee discounts Educational opportunities...Daily paidLocal area
HAN Staff
Albany, NY1 day ago $2,241.8 per month
...Center Hospital Job Type Travel Offering Nursing Profession RN Specialty PICU Job... ...nursing care to pediatric patients in the Cardiac ICU. Utilize Epic systems for documentation and patient management. Monitor...Weekly payContract workLocal areaShift workNight shiftWynn Hospital
Albany, NY3 days ago$2,555 per month
...Details Client Name Albany Medical Center Job Type Travel Offering Nursing Profession RN Specialty PICU Job ID 36587667 Weekly Pay $2555.0 Shift Details Shift Nights 3x12...Hourly payWeekly payShift workNight shiftAlbany Medical Center
Albany, NY5 days ago- Cardiovascular Operating Room Registered Nurse Job Type: Travel Profession: RN Specialty: CVOR Shift Details: 07:00 AM - 05:30 PM Job Order Details: Start Date 09/28/2026 End Date 12/28/2026 Duration 13 Week(s) Client Details: State NYShift work
Albany Medical Center Hospital
Albany, NY1 day ago $2,285 per month
...Details Client Name Albany Medical Center Job Type Travel Offering Nursing Profession RN Specialty PICU Job ID 19050095 Job Title RN - PICU Weekly Pay $2285.0 Shift Details...Weekly payShift workNight shiftMeda Health, LLC
Albany, NY3 days ago$2,015 per month
...Details Client Name Albany Medical Center - HealthTrust Job Type Travel Offering Nursing Profession RN Specialty PICU RN Job ID 37960254 Job Title RN - PICU RN Weekly Pay $2015.0...Weekly payLocal areaShift workNight shiftAlbany Medical Center
Albany, NY4 days ago- Benefits We Offer: Comprehensive health, prescription, dental, vision, life, and disability plans Competitive pay rates Referral opportunities ? Refer a friend & Cash in! Travel reimbursement and per diem allowances Employee discounts Educational opportunities...Daily paidLocal area
Health Advocates Network
Albany, NY5 days ago - ...Job Description Job Description Licensed Practical Nurse (LPN) Duties: Under the direction of a registered nurse, physician, or other licensed health care provider, performs nursing care tasks and procedures consistent with individual treatment plans and scope of...
CDPC
Albany, NY25 days ago - ...Job Description Job description: LPN (Licensed Practical Nurse) Part-time is 24 hours weekly. 1/2 day Friday. (Two Positions... ...create and maintain and follow-up to-do lists for clinical care - Utilize knowledge of physiology and anatomy in patient care - level of...Part timeWork at officeRelocation
HUMERA S SYEDA MD PC
Albany, NY5 days ago $2,376 per month
...Details Client Name Albany Medical Center Hospital Job Type Travel Offering Nursing Profession RN Specialty StepDown Job ID 15829505 Weekly Pay $2376.0 Shift Details Shift 07:00...Hourly payWeekly payShift workWynn Hospital
Albany, NY3 days ago$38 - $47.97 per hour
...LPN Or RN Opportunity At Kimball Farms Nursing Care Center Come join this collaborative and innovated team. At Integritus Healthcare... ...to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor....Hourly payDaily paidFull timeTemporary workPart timeRelocation packageKimball Farms Nursing Care Center
Albany, NY5 days ago$2,641 per month
...Details Client Name Master Albany Medical Center Job Type Travel Offering Nursing Profession RN Specialty Operating Room Job ID 19057136 Job Title RN - Operating Room Weekly Pay $2...Weekly payShift workDay shiftHCA HealthONE Sky Ridge CO
Albany, NY3 days ago- ...DaVita Registered Nurse Make a real impact—every day. As a DaVita RN, you'll ensure compassionate and professional delivery of all dialysis-related nursing services in an outpatient setting, ensuring the safety, comfort, and wellbeing of your patients. You'll work in...Start working today
DaVita
Albany, NY4 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Utilization Review Nurse. Be the first to apply!
Related searches