Clinical Utilization Review Specialist
3 days ago
We are seeking a highly skilled Clinical Utilization Review 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 quality and efficiency of patient care.
Key Responsibilities- Conduct thorough utilization reviews to ensure medical necessity and appropriateness of patient admissions and continued stays.
- Apply MCG criteria to monitor and document findings, identifying areas for clinical documentation improvement and collaborating with the clinical team to implement changes.
- Identify at-risk populations using approved screening tools and develop strategies to mitigate risks.
- Monitor length of stay (LOS) and ancillary resource use, taking proactive steps to achieve continuous improvement.
- Communicate with payors to resolve issues and ensure timely reimbursement.
- Collaborate with the healthcare team to ensure seamless care transitions and optimal patient outcomes.
- Registered Nurse with a current New York State license.
- Bachelor's degree preferred.
- Minimum of three years of clinical experience in an acute care hospital setting.
- Recent experience in case management, utilization management, and/or discharge planning/home care preferred.
- Case Management certification preferred.
- Excellent written and verbal communication skills.
- Working knowledge of MCG criteria and ability to implement and utilize.
- Understanding of Inpatient versus Outpatient surgery and ICD10-Coding (preferred) and Observation status qualifications.
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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Clinical Utilization Review Specialist
1 week ago
Cohoes, New York, United States Albany Medical Center Full timeJob SummaryWe are seeking a highly skilled Clinical Utilization Review 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 quality and efficiency of patient care.Key ResponsibilitiesConduct thorough utilization reviews to ensure medical necessity and...
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Clinical Utilization Specialist
17 hours ago
Cohoes, New York, United States Albany Medical Center Full timeCare Management SpecialistAlbany Medical Center seeks a skilled Care Management Specialist to join our team. As a key member of our Care Management department, you will play a critical role in ensuring the highest quality patient care and outcomes.Responsibilities:Conduct thorough utilization reviews to identify opportunities for improvement in patient care...
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Clinical Nurse Specialist
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Annuities Operations Specialist
3 days ago
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Annuities Operations Specialist
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Application Specialist
1 week ago
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Application Specialist
1 day ago
Cohoes, New York, United States Center for Disability Services Full timeJob Title: Application SpecialistThe Center for Disability Services is seeking a skilled Application Specialist to join our team. As an Application Specialist, you will play a critical role in providing technical and user support for a subset of software applications within the Center.Key Responsibilities:Provide user and technical support to CFDS staff for...
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Diagnostic Imaging Specialist
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Cohoes, New York, United States Albany Medical Center Full timeJob SummaryWe are seeking a highly skilled Clinical Nurse I to join our Progressive Critical Care team at Albany Medical Center. As a key member of our Med/Surg ICU team, you will provide high-quality patient care and contribute to a dynamic, supportive, and fast-paced environment.Key ResponsibilitiesImplement physician orders, administer medications, start...
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Clinical Nurse Specialist
1 week ago
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Nuclear Medicine Technologist II
5 days ago
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Household Operations Manager
2 weeks ago
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Annuities Operations Specialist
1 day ago
Cohoes, New York, United States Innova Solutions Full timeJob SummaryWe are seeking a highly skilled Annuities Operations Analyst to join our team at Innova Solutions. As an Annuities Operations Analyst, you will play a critical role in ensuring the smooth operation of our annuities business.Key ResponsibilitiesReview and approve pending client requests to ensure proper authorizations and supporting documentation...
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Annuities Operations Specialist
2 days ago
Cohoes, New York, United States Innova Solutions Full timeJob SummaryWe are seeking a highly skilled Annuities Operations Analyst to join our team at Innova Solutions. As an Annuities Operations Analyst, you will play a critical role in ensuring the smooth operation of our annuities business.Key ResponsibilitiesReview and approve pending client requests to ensure proper authorizations and supporting documentation...
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Grants and Program Operations Specialist
3 weeks ago
Cohoes, New York, United States Alzheimer's Association Full timePosition Overview: The role involves supporting the Director of Programs and Services in grant analysis, managing the CRM database, and generating reports. Additionally, this position provides administrative assistance to the Programs and Services Department and its volunteers. This is a grant-funded position. Key Responsibilities: The primary duties and...
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Client Onboarding Operations Specialist
2 weeks ago
Cohoes, New York, United States Strategic Staffing Solutions Full timeJob Title: Onboarding Operations AssociateLocation: Cohoes, NYJob Type: Full Time Contract. NO Corp to CorpJob Overview: We are in search of a meticulous and proactive Operations Associate to enhance our operational efficiency. In this capacity, you will be tasked with evaluating and sanctioning outstanding client requests, ensuring that all requisite...
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Radiology Technologist
3 days ago
Cohoes, New York, United States Rezolut Full timeJob OverviewWe are seeking a highly skilled Diagnostic Imaging Specialist to join our team at Rezolut. As a key member of our diagnostic imaging department, you will play a critical role in delivering exceptional patient care and contributing to the success of our organization.Key ResponsibilitiesPerform high-quality diagnostic ultrasound exams, including...
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Grants and Program Operations Specialist
3 weeks ago
Cohoes, New York, United States Alzheimer's Association Full timePosition Overview: The individual in this role will support the Director of Programs and Services in grant analysis, management of the CRM database, and reporting functions. Additionally, this position will provide essential administrative assistance to the Programs and Services Department and its volunteers. This role is funded through grants. Key...
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Medical Sonography Professional
1 week ago
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Nurse Practitioner
9 hours ago
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