The work involves responsibility for assisting in evaluating patients by obtaining data from a thorough chart review of the patient to gather information regarding the utilization of health services in a large Health Care Facility. Under the general supervision of the Patient Evaluation Supervisor, an employee in this class assists in conducting a continuous review of the medical and nursing needs of each patient and resident and assists in recommending to the Utilization Review Committee of Van Duyn Home and Hospital continuation or alteration of the level of care being provided. Supervision is not typically exercised in this class. Does related work as required.




Assists in evaluating patients by reviewing patient charts, physicians orders and progress notes, laboratory reports, ancillary reports, etc., to determine required levels of care.

Assists in recommending to the Utilization Review committee the need to continue current levels of care for each patient and resident; assists in recommending changes in care levels.

Assists in the quarterly review of all residents in the facility and their patient care records to determine facility reimbursement from the resource utilization groups' system or other similar system as required; assists in reviewing quarterly all admissions, transfers and discharges; assists in completing all required forms and reports for the state and federal government.

Reviews the history of prior health care and the present status of all new admissions to determine eligibility for Medicare benefits according to established criteria; answers patients' and families' questions regarding Medicare coverage.

Completes the Medicare Addendum on all Skilled Nursing Facility residents within 30 days of admission, and does continuous review of all eligible (Medicare covered) residents until benefits are exhausted or discontinued.

Maintains a variety of records and prepares reports.

May go to hospitals or private homes to evaluate patients for admission or re-admission.

May participate in evaluation studies and educational programs designed to improve the use of existing services and patient care.

May, in the absence of the Admissions Coordinator, arrange for the admission of a new patient, readmission or transfer within the facility; may answer questions regarding the admission process and nursing home placement procedures.




Thorough knowledge of nursing principles and techniques and their relation to medical practice.

Good knowledge of modern principles and practices in hospital administration.

Good knowledge of state and federal regulations regarding Medicare, Medicaid and other program benefits.

Good knowledge of research techniques applied to nursing studies.

Good knowledge of the practices and procedures of patient evaluation.

Ability to maintain records and prepare written reports.

Ability to communicate effectively both orally and in writing.





Two (2) years of permanent non-competitive class status in the title of Head Nurse, Assistant Head Nurse, Registered Nurse or Registered Nurse(Jail/Correction).


Open Competitive:

Three (3) years of work experience, or its part-time equivalent, as a Registered Nurse.





Special Necessary Requirement

Possession of a current license to practice as a Registered Professional Nurse in New York State at the time of appointment.

Within six (6) months of appointment, must receive a Resource Utilization Groups Assessor license issued by the New York State Office of Health Systems Management, New York State Department of Health.



2/2011 Date Revised