RN - Utilization Review Nurse

The Impact You Can MakeWorks in collaboration with the physician and interdisciplinary team to support the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and removing unnecessary and redundant care, and promoting clinical best practice..Team ImpactThe Glens Falls Hospital ImpactMissionOur Mission is to improve the health of people in our region by providing access to exceptional, affordable, and patient-centered care every day and in every setting.How You Will Fulfill Your PotentialResponsibilities• Conducts concurrent and retrospective review(s) utilizing InterQual (IQ) medical necessity criteria to monitor appropriateness of admissions and continued stays, and documents findings based on department standards; refers appropriate cases to EHR or Physician Advisor for recommendation(s)• Ensures order in chart/EMR and status coincides with the InterQual review or CMS rules and regulations for appropriate Level of Care and status on all patients through collaboration with Care Manager.• Assess the safest and most efficient care level based on severity of illness, comorbidities and complications, and the intensity of services being deliveredEducation/Accredited Programs• Bachelors of Nursing (BSN) is preferred at hire, and is required within 5 years of hire. Exceptions may be made for Associate’s degree RN with relevant experience and obtains certification in case management (CCM or ACM) within 1 year.• Two years of acute care, utilization management, or payer experience preferred.Licenses/Certifications/Registrations• Registered Nurse (RN) in New York StateSkills/Abilities• Ability to function autonomously maintaining a high level of clinical and professional accountability• Demonstrates skill in creative problem solving, facilitation, collaboration, coordination and critical thinking• Embraces change and continuously identifies opportunities for improvement by demonstrating a commitment to creativity and innovation.• Committed to promoting excellence in Customer Service; functions as a team player• Computer literacy and data analysis skills are required• Maintains professional image by demonstrating strong verbal and written communication skills• Demonstrates ability in self-starting, self-directing and clear decision making behaviorsCommunities We ServeLocated in the foothills of the beautiful Adirondack mountains, Glens Falls is conveniently located a short drive away from the capital region and Lake George. Work at the top of your profession and jumpstart your next career here at Glens Falls Hospital!All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law.Salary RangeThe expected base rate for this Glens Falls, New York, United States-based position is $32.00 to $58.74 per hour. Exact rate is determined on a case-by-case basis commensurate with experience level, as well as education and certifications pertaining to each position which may be above the listed job requirements.BenefitsGlens Falls Hospital is committed to providing our people with valuable and competitive benefits offerings, as it is a core part of providing a strong overall employee experience. A summary of these offerings, which are available to active, full-time and part-time employees who work at least 30 hours per week, can be found here.Apply Job!