Albany, NY · On-site
$77K - $119K/yr
While performing utilization review identifies areas for clinical documentation improvement and contacts appropriate department. Identifies at-risk populations using approved screening tool and ...
Albany, NY · On-site
$77K - $119K/yr
While performing utilization review identifies areas for clinical documentation improvement and contacts appropriate department. Identifies at-risk populations using approved screening tool and ...
Albany, NY · On-site
$77K - $119K/yr
... utilization review identifies areas for clinical documentation improvement and contacts appropriate department. • Identifies at-risk populations using approved screening tool and follows ...
New
Albany, NY · On-site
$77K - $119K/yr
... utilization review identifies areas for clinical documentation improvement and contacts appropriate department. • Identifies at-risk populations using approved screening tool and follows ...
New
Albany, NY · On-site
$77K - $119K/yr
... utilization review identifies areas for clinical documentation improvement and contacts appropriate department. • Identifies at-risk populations using approved screening tool and follows ...
Albany, NY · On-site
$77K - $119K/yr
... utilization review identifies areas for clinical documentation improvement and contacts appropriate department. • Identifies at-risk populations using approved screening tool and follows ...
Albany, NY · On-site
$84K - $131K/yr
Most qualified candidates will have experience in Emergency/Trauma Care and/or previous Utilization Review roles. Qualifications and Ideal Characteristics * Registered nurse with a New York State ...
Albany, NY · On-site
$84K - $131K/yr
Most qualified candidates will have experience in Emergency/Trauma Care and/or previous Utilization Review roles. Qualifications and Ideal Characteristics * Registered nurse with a New York State ...
Albany, NY · On-site
$84K - $131K/yr
Most qualified candidates will have experience in Emergency/Trauma Care and/or previous Utilization Review roles. Qualifications and Ideal Characteristics * Registered nurse with a New York State ...
Albany, NY · On-site
$84K - $131K/yr
Most qualified candidates will have experience in Emergency/Trauma Care and/or previous Utilization Review roles. Qualifications and Ideal Characteristics * Registered nurse with a New York State ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental needs. * Plans, implements, and documents utilization management activities which ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental needs. * Plans, implements, and documents utilization management activities which ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental needs. * Plans, implements, and documents utilization management activities which ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental needs. * Plans, implements, and documents utilization management activities which ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental needs. * Plans, implements, and documents utilization management activities which ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental needs. * Plans, implements, and documents utilization management activities which ...
As aNetwork Performance/Utilization Manager, your primary responsibilitiesmay include: * Advise clients on network strategy, provider capacity,utilizationtrends, access challenges, and market ...
As aNetwork Performance/Utilization Manager, your primary responsibilitiesmay include: * Advise clients on network strategy, provider capacity,utilizationtrends, access challenges, and market ...
Be Seen First
Albany, NY · On-site
$60/hr
... utilization review, preferred. * Knowledgeable of current disease/care management/coordination trends, preferred. * Must have OB/maternal health background. * Skills: * * Strong analytical and ...
New
Quick apply
Be Seen First
Albany, NY · On-site
$60/hr
... utilization review, preferred. * Knowledgeable of current disease/care management/coordination trends, preferred. * Must have OB/maternal health background. * Skills: * * Strong analytical and ...
New
Minimum 2 years of experience in utilization review, claims adjudication, medical review, fraud ... Availability to work weekends, holidays, and evening shifts on a rotating basis, as needed. * This ...
Quick apply
Minimum 2 years of experience in utilization review, claims adjudication, medical review, fraud ... Availability to work weekends, holidays, and evening shifts on a rotating basis, as needed. * This ...
A minimum of two (2) years of experience in performing utilization review, claims adjudication ... Weekend, holiday, and evening shift schedules will be assigned on a rotating basis. This is a ...
A minimum of two (2) years of experience in performing utilization review, claims adjudication ... Weekend, holiday, and evening shift schedules will be assigned on a rotating basis. This is a ...
Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance with the appropriate jurisdictional guidelines. * Coordination of medically appropriate care where ...
Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance with the appropriate jurisdictional guidelines. * Coordination of medically appropriate care where ...
Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance with the appropriate jurisdictional guidelines. * Coordination of medically appropriate care where ...
Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance with the appropriate jurisdictional guidelines. * Coordination of medically appropriate care where ...
A minimum of two (2) years of experience performing utilization review, claims adjudication ... Must be available to work weekends, holidays, and evening shifts as needed, assigned on a rotating ...
Quick apply
A minimum of two (2) years of experience performing utilization review, claims adjudication ... Must be available to work weekends, holidays, and evening shifts as needed, assigned on a rotating ...
A minimum of two (2) years of experience performing utilization review, claims adjudication ... Must be available to work weekends, holidays, and evening shifts as needed, assigned on a rotating ...
Quick apply
A minimum of two (2) years of experience performing utilization review, claims adjudication ... Must be available to work weekends, holidays, and evening shifts as needed, assigned on a rotating ...
Albany, NY · On-site
$50/hr
A minimum of two (2) years of experience in performing utilization review, claims adjudication ... Weekend, holiday, and evening shift schedules will be assigned on a rotating basis. * This is a ...
Quick apply
Albany, NY · On-site
$50/hr
A minimum of two (2) years of experience in performing utilization review, claims adjudication ... Weekend, holiday, and evening shift schedules will be assigned on a rotating basis. * This is a ...
A minimum of two (2) years of experience in performing utilization review, claims adjudication ... Weekend, holiday, and evening shift schedules will be assigned on a rotating basis. * This is a ...
A minimum of two (2) years of experience in performing utilization review, claims adjudication ... Weekend, holiday, and evening shift schedules will be assigned on a rotating basis. * This is a ...
Albany, NY · On-site
$77K - $119K/yr
Utilization Review a. Reviews data from admission screening to clarify admission diagnosis, establish appropriate length of stay, and identify any potential outliers and determine appropriateness of ...
Albany, NY · On-site
$77K - $119K/yr
Utilization Review a. Reviews data from admission screening to clarify admission diagnosis, establish appropriate length of stay, and identify any potential outliers and determine appropriateness of ...
Be Seen First
Albany, NY · On-site
$50/hr
A minimum of two (2) years of experience in performing utilization review, claims adjudication ... Weekend, holiday, and evening shift schedules will be assigned on a rotating basis. * This is a ...
Quick apply
Be Seen First
Albany, NY · On-site
$50/hr
A minimum of two (2) years of experience in performing utilization review, claims adjudication ... Weekend, holiday, and evening shift schedules will be assigned on a rotating basis. * This is a ...
$20.70 - $24.89
2% of jobs
$24.89 - $29.07
9% of jobs
$31.94 is the 25th percentile. Wages below this are outliers.
$29.07 - $33.26
21% of jobs
The median wage is $36.65 / hr.
$33.26 - $37.45
23% of jobs
$37.45 - $41.63
13% of jobs
$44.89 is the 75th percentile. Wages above this are outliers.
$41.63 - $45.82
10% of jobs
$45.82 - $50
8% of jobs
$50 - $54.19
5% of jobs
$54.19 - $58.38
5% of jobs
$58.38 - $62.56
2% of jobs
$62.56 - $66.75
2% of jobs
$20
$40
$66
A Weekend Utilization Review job involves assessing patient care and medical services during weekends to ensure they meet medical necessity and insurance guidelines. Professionals in this role review clinical documentation, coordinate with healthcare providers, and determine appropriate levels of care for patients. They typically work for hospitals, insurance companies, or other healthcare organizations. Strong analytical skills, medical knowledge, and familiarity with regulatory requirements are essential for success in this role.
Weekend Utilization Review professionals typically work independently, reviewing patient cases for medical necessity, appropriateness of care, and compliance with payer guidelines during non-standard business hours. You will analyze patient charts, interact with clinical staff, and document findings, often collaborating remotely with other care coordinators or medical teams. While much of the role is desk-based, quick decision-making and effective communication are essential due to faster-paced weekend workflows. This schedule can offer greater autonomy and flexibility, but may also require prioritizing tasks and managing multiple cases efficiently to ensure continuous patient care.
Success as a Weekend Utilization Review professional requires a strong background in nursing or healthcare, critical thinking skills, and a thorough understanding of medical necessity criteria, such as InterQual or Milliman guidelines. Familiarity with electronic medical records (EMR) systems and utilization management software is highly beneficial, and RN or healthcare-related licensure is often required. Exceptional communication, attention to detail, and the ability to work independently on weekends are crucial soft skills. Mastering these areas allows efficient and accurate reviews of patient care, supporting optimal healthcare resource allocation outside of standard work hours.
The most popular types of Utilization Review jobs in Schenectady, NY are:
For Weekend Utilization Review jobs in Schenectady, NY, the most frequently searched job titles are:
The top searched job categories for Weekend Utilization Review jobs in Schenectady, NY are:
Cities near Schenectady, NY with the most Weekend Utilization Review job openings:
$77K - $119K/yr
Full-time
Posted 4 days ago
Department/Unit:
Care Management/Social WorkWork Shift:
Day (United States of America)Salary Range:
$77,075.00 - $119,466.00Responsible 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.
