Clinical Utilization Specialist

3 weeks ago


Wynantskill, New York, United States Albany Medical Center Full time
Job Summary

We are seeking a skilled Clinical Utilization Specialist to join our team at Albany Medical Center. As a key member of our Care Management department, you will play a critical role in ensuring the efficient and effective delivery of patient care.

Key Responsibilities
  • Conduct thorough utilization reviews to identify opportunities for improvement in patient care and resource utilization.
  • Collaborate with healthcare teams to develop and implement effective care plans that meet the unique needs of each patient.
  • Apply MCG criteria to monitor the appropriateness of admissions and continued stays, and document findings in accordance with departmental standards.
  • Identify areas for clinical documentation improvement and work with the quality department to implement changes.
  • Monitor length of stay and ancillary resource use, taking proactive steps to achieve continuous improvement.
  • Communicate with payors to resolve issues and ensure timely reimbursement.
  • Participate in quality screens to identify potential issues and contribute to the development of quality improvement initiatives.
Requirements
  • Registered nurse with a New York State current license.
  • Bachelor's degree preferred.
  • Minimum of three years clinical experience in an assigned service.
  • Recent experience in case management, utilization management, and/or discharge planning/home care in a high-volume, acute care hospital preferred.
  • Case Management certification preferred.
What We Offer

Albany Medical Center is an equal opportunity employer. This role may require access to sensitive information, and we expect our workforce members to ensure that access is based on a 'need to know' and is the minimum necessary to properly perform assigned duties.



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