Utilization Review Nurse
Florida Hospital Association
Date: 7 hours ago
City: Schenectady, New York
Contract type: Full time
This role in Care Management/Social Work involves
- Performing Utilization Management, Quality Screening, and Delay Management for patients, applying MCG criteria to monitor admissions and stays, and documenting findings.
- Identifying at-risk populations, monitoring length of stay and resource use, and collaborating with the healthcare team to improve care and resolve payor issues.
- Facilitating delay removal, reporting delays, and ensuring communication across teams.
- Requirements include being a licensed RN in NY, with 3+ years clinical experience, knowledge of MCG criteria, and strong communication and organizational skills. Certification and experience in case management preferred.
- Understanding of regulatory requirements, ICD10-Coding, and healthcare processes is advantageous.
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