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Clinical Utilization Specialist
2 months ago
Albany Medical Center seeks a skilled Clinical Utilization Specialist to join our Care Management team. In this role, you will be responsible for ensuring the efficient and effective use of healthcare resources while maintaining high-quality patient care.
Key Responsibilities- Conduct thorough reviews of patient admissions and continued stays to ensure appropriateness and quality of care.
- Apply MCG criteria to identify areas for clinical documentation improvement and collaborate with the clinical team to implement changes.
- Identify at-risk populations and develop strategies to improve outcomes.
- Monitor length of stay and ancillary resource use, taking proactive steps to reduce unnecessary utilization.
- Communicate with payors and clinical staff to resolve issues and ensure seamless care transitions.
- 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 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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