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Medicare Rn Jobs in Schenectady, NY (NOW HIRING)

Albany Med

Utilization Review Nurse

Albany, NY · On-site

$77K - $119K/yr

Minimum Qualifications: • Registered nurse with a New York State current license. • Associate ... Medicare regulatory requirements, Managed Care Plans Thank you for your interest in Albany Med ...

Phenom People

Licensed Practical Nurse

Schenectady, NY · On-site

$4.0K/wk

... to a physician or registered nurse in order to provide information useful in diagnosis and ... participation in the Medicare and Medicaid programs. Continued employment will depend on ...

Albany Medical Center

Utilization Review Nurse

Albany, NY · On-site

$77K - $119K/yr

Minimum Qualifications: • Registered nurse with a New York State current license. • Associate ... Medicare regulatory requirements, Managed Care Plans Thank you for your interest in Albany Med ...

Saratoga Hospital

Social Worker

Saratoga Springs, NY · On-site

$30.32 - $49.79/hr

This Social Worker position will interface in collaboration with RN care managers and ... Medicare guidelines for pursuing transfer to a skilled nursing facility from the acute hospital ...

Saratoga Hospital

Social Worker

Saratoga Springs, NY · On-site

$63K - $103K/yr

This Social Worker position will interface in collaboration with RN care managers and ... Medicare guidelines for pursuing transfer to a skilled nursing facility from the acute hospital ...

Wells Nursing Home, Inc

Physical Therapist

Johnstown, NY · On-site

$80K - $85K/yr

Must possess a current unencumbered NYS license as a Registered Professional Physical Therapist ... Makes appropriate recommendations for nursing regarding mobility, positioning and ROM resident ...

Sodus Rehab & Nursing Center

Physical Therapist

Johnstown, NY · On-site

$1.5K - $1.9K/wk

Must possess a current unencumbered NYS license as a Registered Professional Physical Therapist ... Makes appropriate recommendations for nursing regarding mobility, positioning and ROM resident ...

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All JobsMedicare Rn JobsMedicare Rn Jobs in Schenectady, NY

Medicare Rn information

What does a Medicare RN do?

A Medicare RN is a registered nurse who specializes in providing care and managing cases for patients covered under Medicare, the federal health insurance program for people 65 and older or with certain disabilities. Their duties often include patient assessments, developing care plans, coordinating services, ensuring compliance with Medicare regulations, and educating patients and families about their healthcare options. They may work in hospitals, home health agencies, or long-term care facilities, helping to optimize patient outcomes while ensuring proper documentation for Medicare reimbursement.

What are the key skills and qualifications needed to thrive as a Medicare RN, and why are they important?

To thrive as a Medicare RN, you need a comprehensive understanding of clinical nursing practices, Medicare regulations, and care coordination, typically supported by an active RN license and experience in case management or utilization review. Familiarity with Medicare documentation requirements, electronic health records (EHRs), and case management software is essential. Strong communication, attention to detail, and critical thinking skills help Medicare RNs effectively advocate for patients and collaborate with healthcare teams. These skills ensure compliance with regulations, optimize patient outcomes, and support efficient healthcare delivery within the Medicare system.

What are the typical challenges Medicare RNs face when coordinating patient care across multiple providers?

Medicare RNs often encounter challenges related to coordinating care among various healthcare providers, such as physicians, specialists, and home health agencies. Navigating different documentation systems and ensuring timely communication can be complex, especially when managing patients with multiple chronic conditions. Effective organization, strong communication skills, and a thorough understanding of Medicare guidelines are essential for overcoming these challenges and providing seamless care transitions.

What is the difference between Medicare Rn vs Home Health Nurse?

AspectMedicare RnHome Health Nurse
CredentialsRegistered Nurse license, Medicare certificationRegistered Nurse license, home health certification
Work EnvironmentHospitals, clinics, Medicare facilitiesPatients' homes, community settings
Employer & IndustryMedicare providers, healthcare agenciesHome health agencies, hospice services
Search & Comparison IntentMedicare Rn vs Home Health NurseMedicare Rn vs Home Health Nurse

Both Medicare Rns and Home Health Nurses are registered nurses working within the Medicare system. While Medicare Rns often work in clinics or hospitals providing Medicare-related care, Home Health Nurses focus on delivering nursing services directly in patients' homes. Both roles require RN licensure, but their work environments and employer types differ, reflecting their specific patient care settings.

What are popular job titles related to Medicare Rn jobs in Schenectady, NY?

For Medicare Rn jobs in Schenectady, NY, the most frequently searched job titles are:

What job categories do people searching Medicare Rn jobs in Schenectady, NY look for?

The top searched job categories for Medicare Rn jobs in Schenectady, NY are:

What cities near Schenectady, NY are hiring for Medicare Rn jobs?

Cities near Schenectady, NY with the most Medicare Rn job openings:

Medicare Rn jobs near you
Infographic showing various Medicare Rn job openings in Schenectady, NY as of August 2026, with employment types broken down into 3% As Needed, 60% Full Time, 15% Part Time, and 22% Contract. Highlights an 99% Physical, and 1% Remote job distribution.

Utilization Review Nurse

Albany Med

Albany, NY • On-site

$77K - $119K/yr

Other

Posted 8 days ago

Job description

Department/Unit:
Care Management/Social Work
Work Shift:
Day (United States of America)
Salary Range:
$77,075.00 - $119,466.00
Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients.
• Completes Utilization Management and Quality Screening for assigned patients.
• Applies MCG criteria to monitor appropriateness of admissions and continued stays, and documents findings based on Departmental standards.
• While performing utilization review identifies areas for clinical documentation improvement and contacts appropriate department.
• Identifies at-risk populations using approved screening tool and follows established reporting procedures.
• Monitors LOS and ancillary resource use on an ongoing basis. Takes actions to achieve continuous improvement in both areas.
• Refers cases and issues to Medical Director and Triad Team in compliance with Department procedures and follows up as indicated.
• Communicates 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.
• Uses quality screens to identify potential issues and forwards information to the Quality Department.
• Demonstrates proper use of MCG and documentation requirements through case review and inter-rater reliability studies.
• Facilitates removal of delays and documents delays when they exist. Reports internal and external delays to the Triad Team.
• Collaborates 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.
Minimum Qualifications:
• Registered nurse with a New York State current license.
• Associate's degree required. Bachelor's degree preferred.
• Minimum of three years clinical experience in an assigned service.
• Recent experience in case management, utilization management and/or discharge planning/home care in a high volume, acute care hospital preferred. PRI and
• Case Management certification preferred.
• Assertive and creative in problem solving, critical thinking skills, systems planning and patient care management.
• Self-directed with the ability to adapt in a changing environment.
• Basic knowledge of computer systems with skills applicable to utilization review process.
• Excellent written and verbal communication skills.
• Working knowledge of MCG criteria and ability to implement and utilize.
• Understanding of Inpatient versus Outpatient surgery and ICD10-Coding (preferred) and Observation status qualifications.
• Ability to work independently and demonstrate organizational and time management skills.
• Strong analytic, data management and PC skills.
• Working knowledge of Medicare regulatory requirements, Managed Care Plans
Thank you for your interest in Albany Med Health System!
Albany Med Health System is an equal opportunity employer.
This 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:
Access 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.

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