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Clinical Utilization Review Specialist
2 months ago
Albany Medical Center is seeking a skilled Clinical Utilization Review Specialist to join our team. As a key member of our Care Management/Social Work department, you will be responsible for ensuring the efficient and effective use of healthcare resources.
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 needs of patients and reduce unnecessary costs.
- Apply MCG criteria to monitor appropriateness of admissions and continued stays, and document findings based on 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 actions to achieve continuous improvement in both areas.
- Communicate with payors and resolve issues on a case-by-case basis.
- 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.
Albany Medical Center is an equal opportunity employer. This role may require access to sensitive information, and workforce members are expected to ensure that access is based on a 'need to know' and is the minimum necessary to properly perform assigned duties.
