Clinical Utilization Review Specialist
2 days ago
We are seeking a skilled Clinical Utilization Review Specialist to join our team at Albany Medical Center. As a key member of our Care Management/Social Work department, you will play a critical role in ensuring the highest quality patient care while optimizing resource utilization.
Key Responsibilities- Conduct thorough utilization reviews to identify opportunities for improvement in patient care and resource allocation.
- Collaborate with healthcare teams to develop and implement effective care plans that meet patient needs and optimize resource utilization.
- 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 (LOS) 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.
- Use quality screens to identify potential issues and forward information to the quality department.
- 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.
- Assertive and creative problem-solving skills, critical thinking, systems planning, and patient care management.
- Self-directed with the ability to adapt in a changing environment.
- Basic knowledge of computer systems with skills applicable to utilization review process.
- Excellent written and verbal communication skills.
- Working knowledge of MCG criteria and ability to implement and utilize.
Albany Medical Center is an equal opportunity employer. This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners. Workforce members are expected to ensure that access to information 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
3 days ago
Delmar, New York, United States Albany Medical Center Full timeJob SummaryWe are seeking a 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 efficient and effective delivery of patient care.Key ResponsibilitiesConduct thorough utilization reviews to identify opportunities for...
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Clinical Utilization Review Specialist
1 week ago
Delmar, New York, United States Albany Medical Center Full timeJob SummaryAlbany Medical Center is seeking a skilled Clinical Utilization Review Specialist to join our team. 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 identify opportunities for improvement in patient...
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Clinical Utilization Review Specialist
5 days ago
Delmar, New York, United States Albany Medical Center Full timeJob SummaryAlbany Medical Center is seeking a skilled Clinical Utilization Review Specialist to join our team. 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 identify opportunities for improvement in patient...
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Clinical Nurse Specialist
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RN Unit Manager
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MDS Coordinator for Long Term Care
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