Utilization Review Nurse — Hybrid/Remote Care Optimizer

Vassar Brothers Medical Center; City of Poughkeepsie (NY); On-site; USD 100,000 - 153,000; Full time

Job summary

Vassar Brothers Medical Center in Poughkeepsie, NY is seeking a skilled Utilization Review Nurse to perform clinical reviews, determine level of care, and collaborate with physicians to ensure appropriate patient placement and regulatory compliance.

The role emphasizes payer communications, documentation in Cerner, and adherence to InterQual/MCG criteria, with hybrid work options and a focus on accuracy, HIPAA, and timely decisions.

Qualifications

• Associate's degree in nursing required.
• 3 years experience in acute or subacute nursing required.
• 3 years experience as Utilization Management Nurse preferred.
• Current NYS RN License required.
• CCM/ACM preferred; required within 60 days of hire. MCG Certification preferred.

Responsibilities

• Clinical Review & level of care determination including inpatient, observation, and outpatient status.
• Payer communication, documentation, and authorization management in Cerner.
• Collaboration with attending MD and Physician Advisor for reviews and escalations.
• Compliance with HIPAA, CMS, and payer rules; maintain performance standards.
• Adhere to hybrid work standards as outlined in policy.

Education

Associate's degree in nursing

Bachelor's degree or master's degree in nursing (preferred)

Job description

Vassar Brothers Medical Center in Poughkeepsie, NY is seeking a skilled Utilization Review Nurse to perform clinical reviews, determine level of care, and collaborate with physicians to ensure appropriate patient placement and regulatory compliance.

The role emphasizes payer communications, documentation in Cerner, and adherence to InterQual/MCG criteria, with hybrid work options and a focus on accuracy, HIPAA, and timely decisions.