Utilization Review Coordinator

Kaleida Health; Buffalo (NY); On-site; USD 97,000 - 124,000; Full time

Job summary

Kaleida Health's Utilization Review Coordinator position at Buffalo General Medical Center in Buffalo, NY, requires coordination of utilization management and case reviews to align patient needs with resources. The role covers preadmission, ambulatory surgery, clinic, physician offices and inpatient settings.

BSN and NYS RN registration are required, with CCM preferred. A mix of nursing experience in acute care, case management and utilization review is expected.

Qualifications

• Bachelor of Science degree in Nursing and NYS RN registration.
• CCM preferred; 3+ years in acute care nursing with 2 years in case management/utilization review.
• Proficiency with Microsoft Office Suite and Outlook; familiarity with health care software.
• Knowledge of Interqual Criteria Set and related software preferred.

Responsibilities

• Coordinate utilization management/case review to align patient needs with resources and outcomes.
• Perform case reviews in preadmission, ambulatory surgery, clinic, physician office and inpatient settings.
• Work full-time onsite with 8a-4p schedule.
• Onsite utilization review coordination at Buffalo General Medical Center.

Skills

Acute care nursing

Case management

Education

Bachelor of Science in Nursing

NYS Registration as a Professional Nurse

Certified Case Manager (CCM) preferred

3 years experience in acute care nursing

Tools

Microsoft Office Suite

Interqual Criteria Set/Software

Job description

Utilization Review CoordinatorDepartment: BGMC Utilization ReviewLocation: Buffalo General Medical CenterLocation of Job: US:NY:BuffaloWork Type: Full-TimeScheduled Work Hours: 8a-4pShift 1 Job DescriptionPosition responsible for coordinating utilization management/case review efficiently and effectively while aligning current and prospective patients' needs with resources to meet quality, clinical and cost outcomes working to achieve optimal outcomes for the patient. Case review may occur in preadmission, ambulatory surgery, clinic, physician office and impatient setting. Education And CredentialsBS

• Bachelor of Science degree in Nursing. Current NYS Registration as a Professional Nurse. Certified Case Manager (CCM) preferred. Experience3 years of experience in acute care nursing. 2 years of experience in any combination of: case management, home care and utilization review. Working knowledge of Microsoft Office Suite and Outlook. Use of computer applications related to health care industry. Knowledge of and experience with Interqual Criteria Set and Software Systems preferred. Employees in the job title prior to 3/29/10 are grandfathered and are not required to obtain their BSN.
• Working ConditionsEssential:
• Weight Requirement
• Light (up to 20 lbs)
• Job DetailsStandard Hours Bi-Weekly: 75.00
• FTE: 1.000000
• Weekend/Holiday Requirement: Yes
• On Call Required: No
• With Rotation: Work Arrangement: Onsite
• Union Code: U06
• CWA 1168 BGH RN
• Requisition ID#: 16674
• Grade: RN3
• Pay Frequency: Bi-Weekly
• Salary Range: $46.44 -$59.42
• Wage will be determined based on factors such as candidate's experience, qualifications, internal equity, and any applicable collective bargaining agreement.
• Kaleida Healths mission is to advance the health of our community, and we believe our diversity, equity, and inclusion (DEI) strategic work is mission- critical for the good of our workforce and the community who need and depend on our care and services. We understand that racism and health inequities stand firmly in the way of advancing the health of our community, and Kaleida Health envisions DEI as the pursuit of equity and restorative justice for every person. We will exemplify courage and accountability through both the professing and practice of our core values for our friends, colleagues, and community. Kaleida Health is committed to creating a culture of equity and inclusion where diversity is valued and celebrated!