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The ImpactYou Can Make Works in collaboration with the physician and interdisciplinary team to support the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and removing unnecessary and redundant care, and promoting clinical best practice. Ensuring all patients receive “the right care, the right cost, right time, and in the right setting.” The Glens Falls Hospital Impact Mission Our Mission is to improve the health of people in our region by providing access to exceptional, affordable, and patient-centered care every day and in every setting. * * How You Will Fulfill Your Potential Responsibilities * Conducts concurrent and retrospective review(s) utilizing InterQual (IQ) medical necessity criteria to monitor appropriateness of admissions and continued stays, and documents findings based on department standards; refers appropriate cases to EHR or Physician Advisor for recommendation(s) * Ensures order in chart/EMR and status coincides with the InterQual review or CMS rules and regulations for appropriate Level of Care and status on all patients through collaboration with Care Manager. Demonstrates thorough knowledge in the application of InterQual medical necessity criteria: * Assess the safest and most efficient care level based on severity of illness, comorbidities and complications, and the intensity of services being delivered * Utilizes IQ Criteria to provide recommendation(s) to the attending physician * Communicates payor criteria and issues on a case-by-case basis with multidisciplinary team and follows up to resolve problems with payors as needed; initiates peer to peer when appropriate Education & Experience * Bachelors of Nursing (BSN) is preferred at hire, and is required within 5 years of hire. Exceptions may be made for Associate’s degree RN with relevant experience and obtains certification in case management (CCM or ACM) within 1 year. * Two years of acute care, utilization management, or payer experience preferred. Licenses, Certifications, Registrations: * Registered Nurse (RN) in New York State Skills and Abilities: * Ability to function autonomously maintaining a high level of clinical and professional accountability * Demonstrates skill in creative problem solving, facilitation, collaboration, coordination and critical thinking * Embraces change and continuously identifies opportunities for improvement by demonstrating a commitment to creativity and innovation. * Committed to promoting excellence in Customer Service; functions as a team player * Computer literacy and data analysis skills are required * Maintains professional image by demonstrating strong verbal and written communication skills * Demonstrates ability in self-starting, self-directing and clear decision making behaviors Salary Range The expected base rate for this Glens Falls, New York, United States-based position is $32.00 to $58.74 per hour. Exact rate is determined on a case-by-case basis commensurate with experience level, as well as education and certifications pertaining to each position which may be above the listed job requirements. Benefits Glens Falls Hospital is committed to providing our people with valuable and competitive benefits offerings, as it is a core part of providing a strong overall employee experience. A summary of these offerings, which are available to active, full-time and part-­time employees who work at least 30 hours per week, can be foundhere. *Job: Nursing - Case Management *Title: *Registered Nurse - Utilization Review Nurse - Care Management (Sign-On Bonus for Full-Time & Part-Time Positions, Shift-Differentials) Location: NY-Glens Falls Requisition ID: 240BN