Utilization Review Nurse Job at Florida Hospital Association, Schenectady, NY

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  • Florida Hospital Association
  • Schenectady, NY

Job Description

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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