Registered Nurse - Quality & Utilization Review Coordinator - SUNYUPNYRN Job at NavitsPartners, Cobleskill, NY

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  • NavitsPartners
  • Cobleskill, NY

Job Description

Registered Nurse – Quality & Utilization Review Coordinator

Qualifications:

  • RN license with experience in quality assurance or utilization review.
  • Minimum of 3 years in a hospital or managed care setting.
  • Knowledge of regulatory standards, including CMS and Joint Commission guidelines.
  • Strong written and verbal communication skills.
  • Proficiency in data analysis and performance improvement strategies.

Duties:

  • Assess healthcare services for efficiency, effectiveness, and compliance.
  • Conduct retrospective and concurrent medical necessity reviews.
  • Develop and implement quality improvement initiatives.
  • Analyze trends in utilization and make recommendations for policy adjustments.
  • Work closely with case managers and providers to optimize patient outcomes.
  • Ensure adherence to accreditation and regulatory requirements.

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