RN Analyst

Per the Collective Bargaining Agreement, current

bargaining unit employees have priority consideration for this

position if they apply within seven (7) days of the posting date.

After this period, all applicants will be considered equally.

GENERAL SUMMARY : The Utilization Review RN monitors, collects and

analyzes data and evaluates variances of resource utilization,

complications and overall quality of care based on benchmarked

criteria or established practices. The Utilization Review RN in

utilizing these skills assists the Medical Center in providing

optimal care in a cost effective manner and promotes the efficient

and effective use of patient services. The Utilization Review RN

role in data collection, analysis and summarization supports the

Medical Centers performance improvement / quality program, risk

management, clinical pathway development and outcome measurement

using guidelines from third party payors and external agency review

processes. The Utilization Review RN utilizes his / her skills to

coordinate internal and external resources to facilitate

appropriate resource management of an age specific patient

population which spans from newborns to geriatrics, identifying

opportunities for process improvement, high risk cases and sentinel

events, to the achievement of an acceptable outcome.

QUALIFICATIONS : 1. Current New York State Registered Nurse license

required. 2. CCM Preferred. Utilization review and discharge

planning experience preferred. 3. Three years of broad clinical

nursing experience is required. 4. Quality assurance / risk

management experience preferred. 5. Experience with interqual

preferred. Knowledge of MCG a plus. 6. A high level of

interpersonal skills and professional poise to interact with

Medical Staff, other department staff, and Medical Center

management is required. 7. Knowledge of the prospective payment

system and current insurers payment methodologies, coding and

sequencing, and data collection and analysis is preferred. 8.

Assessment and goal setting skills, project management skills, and

problem solving skills are required. 9. Knowledge of Medicare,

Department of Health, and The Joint Commission regulations is

preferred. 10. Knowledgeable in managed care processes is

preferred. Computer experience preferred. 11. Good written and

verbal communication skills.