About this opportunity
Albany Medical Center lists this Utilization Review Nurse: Emergency Dept opportunity in albany, New York. Review the employer’s description below for duties, qualifications and application requirements.
Job description
43 New Scotland Avenue Albany, NY 12208
nFull time
n69429
nDepartment/Unit:
nCare Management/Social Work
nWork Shift:
nDay (United States of America)
nSalary Range:
n$84,783.00 - $131,414.00
nResponsible for Utilization Management, Quality Screening and Delay Management for assigned patients.
nMost qualified candidates will have experience in Emergency/Trauma Care and/or previous Utilization Review roles.
nQualifications and Ideal Characteristics
nnnRegistered nurse with a New York State current license.
n
nnBachelor's degree required. Masters degree preferred.
n
nnMinimum of three years clinical experience in an assigned service.
n
nnRecent experience in case management, utilization management and/or discharge planning/home care in a high volume, acute care hospital preferred. PRI and
n
nnCase Management certification preferred.
n
nnAssertive and creative in problem solving, critical thinking skills, systems planning and patient care management.
n
nnSelf-directed with the ability to adapt in a changing environment.
n
nnBasic knowledge of computer systems with skills applicable to utilization review process.
n
nnExcellent written and verbal communication skills.
n
nnWorking knowledge of MCG criteria and ability to implement and utilize.
n
nnUnderstanding of Inpatient versus Outpatient surgery and ICD10-Coding (preferred) and Observation status qualifications.
n
nnAbility to work independently and demonstrate organizational and time management skills.
n
nnStrong analytic, data management and PC skills.
n
nnWorking knowledge of Medicare regulatory requirements, Managed Care Plans
n
n nA. Mission, Core Values and Service Excellence
nnnContributes to the creation of a compassionate and caring environment for patients, families, and colleagues through displays of kindness and active listening. Recognizes and appreciates that each employee’s work is valuable and contributes to the success of the Mission.
n
nnDemonstrates excellence in daily work. Willing to actively participate in performance and quality improvement activities and to work towards enhancing customer/patient satisfaction.
n
nnExhibits positive service excellence skills to patients, visitors, and coworkers by greeting others in a friendly manner, keeping customers/patients/colleagues informed about progress, delays, and changes.
n
nnDemonstrates effective teamwork by interacting in a positive manner with colleagues and creating a collaborative work environment. Initiates open communication, conveys positive intent, offers assistance.
n
nnContributes to a safe and secure environment for patients, visitors, colleagues by following established procedures and protocols.
n
nnDemonstrates stewardship by thoughtful and responsible use of resources including maintaining a clean and hospitable environment, starting work on time, displaying a consciousness regarding costs, supplies and department finances.
n
nnDemonstrates respect for individual differences of each person by acknowledging the essence of each person, appreciating, and responding to unique, spiritual, personal, and cultural backgrounds of patients, families, and colleagues.
n
n nB. Utilization Management
nnnCompletes Utilization Management and Quality Screening for assigned patients.
n
nnApplies MCG criteria to monitor appropriateness of admissions and continued stays, and documents findings based on Departmental standards.
n
nnWhile performing utilization review identifies areas for clinical documentation improvement and contacts appropriate department.
n
nnIdentifies at-risk populations using approved screening tool and follows established reporting procedures.
n
nnMonitors LOS and ancillary resource use on an ongoing basis. Takes actions to achieve continuous improvement in both areas.
n
nnRefers cases and issues to Medical Director and Triad Team in compliance with Department procedures and follows up as indicated.
n
nnCommunicates 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.
n
nnUses quality screens to identify potential issues and forwards information to the Quality Department.
n
nnDemonstrates proper use of MCG and documentation requirements through case review and inter-rater reliability studies.
n
nnDelay Management
n
nnFacilitates removal of delays and documents delays when they exist. Reports internal and external delays to the Triad Team.
n
nnCollaborates 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.
n
nnMaintains complete confidentiality of patient information, in addition to hospital and individual physician practice pattern data. Provides information and inservices as necessary to physicians and ancillary staff.
n
n nThank you for your interest in Albany Med Health System!
nAlbany Med Health System is an equal opportunity employer.
nThis 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:
nAccess 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.
nAlbany Medical Center is the centerpiece of medicine, research, and medical education in New York’s CapitalRegion and is the area's largest private employer with more than 10,000 employees.
nAlbany Medical Center offers excellent career opportunities in a wide range of roles in both patient care andadministration. We value all our staff members and offer outstanding employee benefits ( including:
n· Excellent health care coverage with no copay at Albany Medical Center providers
n· A wide array of services and programs to support emotional, physical, and mental wellbeing
nAnchored in the state’s historic capital city, Albany Medical Center offers a full range of inpatient and outpatient careand is home to the region’s largest hospital, only Level 1 adult and pediatric trauma centers, and only children’s hospital. Thedowntown campus also offers opportunities at Albany Medical College.
nAlbany Medical Center ( , along with Columbia Memorial Health ( , Glens Falls Hospital ( , Saratoga Hospital ( , and the Visiting Nurses ( , form the Albany Med Health System, serving more than three million people over 25 counties.
Worksite address
albany, NY, 12237, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.