Clinical Utilization Review Specialist
4 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 Quality Department 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 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.
- 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.
-
Nurse Practitioner
4 days ago
Glenmont, New York, United States Albany Medical Center Full timeJob SummaryWe are seeking a highly skilled and experienced Nurse Practitioner to join our team at Albany Medical Center. As a key member of our Anesthesiology department, you will be responsible for providing high-quality patient care and management of acute pain services.Key ResponsibilitiesPerform inpatient consultations and coordinate care with...
-
Nurse Practitioner
9 hours ago
Glenmont, New York, United States Albany Medical Center Full timeJob SummaryWe are seeking a highly skilled and experienced Nurse Practitioner to join our team at Albany Medical Center. As a key member of our Anesthesiology department, you will be responsible for providing high-quality patient care and management of acute pain services.Key ResponsibilitiesPerform inpatient consultations and coordinate care with...
-
Glenmont, New York, United States Matrix Medical Network Full timePosition Overview: Nurse Practitioner/Physician Assistant – PRN Home Risk Assessments with competitive compensation About Matrix Medical Network: Matrix Medical Network specializes in delivering a comprehensive array of clinical services, empowering primary care providers and at-risk health plan members with essential tools and insights to effectively...
-
Lead Financial Analyst
1 week ago
Glenmont, New York, United States Adams and Associates, Inc. Full timePOSITION SUMMARYThe Senior Accountant is responsible for ensuring that payroll systems, processes, and deliverables are established and executed with precision, timeliness, and adherence to company protocols. This role involves analyzing systems and data, utilizing sound judgment to address issues and challenges. The Senior Accountant also provides essential...
-
Lead Financial Accountant
2 weeks ago
Glenmont, New York, United States Adams and Associates, Inc. Full timePOSITION OVERVIEWThe Senior Accountant is responsible for ensuring that payroll systems, processes, and deliverables are established and executed with precision, timeliness, and in alignment with the company's policies. This role involves analyzing systems and data, utilizing sound judgment to address issues and challenges. The Senior Accountant provides...
-
Clinical Utilization Review Nurse
2 weeks ago
Glenmont, United States Albany Medical Center Full timeDepartment/Unit: Care Management/Social Work Responsibilities: Conduct utilization management and quality screening for assigned patients Apply MCG criteria to assess appropriateness of admissions and continued stays Identify areas for clinical documentation improvement and collaborate with relevant departments Monitor length of stay and resource use,...
-
Field Service Specialist
1 week ago
Glenmont, Maryland, United States Clean Harbors Full timeAbout Clean HarborsClean Harbors is a leading provider of environmental, energy, and industrial services throughout the United States, Canada, Mexico, and Puerto Rico. We are a company that solves tough problems through innovation and proven methodology.Job SummaryWe are seeking a Field Service Specialist to join our team. The successful candidate will be...
-
Field Service Specialist
3 months ago
Glenmont, United States Clean Harbors Full timeClean Harbors in Glenmont, NY is seeking a Field Service Sales Rep (Field Service Specialist) to scope projects, provide client support, and prepare proposals/cost estimates. Environmental Projects include remediation, emergency response services, scheduled maintenance, and other field services. Starting pay is $65-80K Clean Harbors is the leading provider...
-
HR Coordinator
11 hours ago
Glenmont, Maryland, United States Adams and Associates Full timeJob SummaryThe HR Coordinator - Talent Acquisition Specialist will provide administrative and technical support to the Human Resources function at Adams and Associates. This role will analyze human resources policy and procedures, determine applicants' eligibility, and use proper judgment and discretion to resolve issues and problems. The successful...
-
Support Specialist for Property Management
1 week ago
Glenmont, Maryland, United States Acquired Philadelphia Full timeJob OverviewWe are seeking a dedicated Assistant Property Manager to support the Property Manager in overseeing the daily operations of our properties. This role is essential in ensuring tenant satisfaction and maintaining the quality of our facilities.Key ResponsibilitiesServe as the primary contact for tenants, addressing their inquiries and concerns in a...
-
Bilingual Customer Service Specialist
2 weeks ago
Wheaton-Glenmont, United States Sherwin-Williams Full timeCustomer Service Specialists work closely with wholesale and retail customers to determine their needs, answer their questions about Sherwin-Williams products, and recommend the right solutions. Store associates Customer Service Specialists are also expected to promptly resolve any customer concerns and ensure maximum client satisfaction as well as stay...
-
Glenmont, United States Hueman Risk Adjustment Full timeJob DescriptionJob DescriptionHueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Glenmont, NY. This unique opportunity adapts to your lifestyle, giving you the freedom to achieve your professional goals on your terms, all while enjoying a...
-
Manufacturing Process Engineer
2 weeks ago
Glenmont, Ohio, United States Replex Plastics Inc Full timePosition Overview: Replex Plastics Inc, a leading manufacturer established in 1991, is in search of a dedicated Production Engineer to enhance its leadership team. This full-time salaried role offers a competitive salary range of $60,000 to $90,000, commensurate with experience, along with comprehensive benefits.5 PTO days after 6 months (10 days at a year)1...
-
Nurse Practitioner or Physician Assistant
1 month ago
Glenmont, United States MRG Exams Full timeWork can be performed by a Nurse Practitioner or Physician AssistantWe are looking for the right Nurse Practitioner or Physician Assistant to perform medical assessments on United States Veterans as part of the VA's disability benefits process.In performing Disability Assessments, you will review medical records electronically through a web portal and...
-
Nurse Practitioner or Physician Assistant
1 month ago
Glenmont, United States MRG Exams Full timeWork can be performed by a Nurse Practitioner or Physician AssistantWe are looking for the right Nurse Practitioner or Physician Assistant to perform medical assessments on United States Veterans as part of the VA's disability benefits process.In performing Disability Assessments, you will review medical records electronically through a web portal and...
-
Field Service Supervisor
1 month ago
Glenmont, United States Clean Harbors Full timeHepaco, a Clean Harbors company in Glenmont, NY is seeking a Field Service Supervisor to plan, lead, organize and coordinate the daily operations of the service line crew. This includes responsibility over proper operation of equipment, driving operational efficiencies at the work site and ensuring accurate documentation related to the job is completed in...
-
Counselor
2 months ago
Glenmont, United States Carpenter Management Group (Glenmont Job Corps) Full timeAbout Job Corps: Join us and make a huge impact in the next generation! Job Corps is a free education and training program that helps young people earn a high school diploma or GED, learn a career, and find and keep a good job. Job Corps centers provide a safe environment where students can focus on their education and career training. Position Summary: We...
-
Recreation Advisor
2 weeks ago
Glenmont, United States Adams and Associates, Inc. Full timeAbout Glenmont Job Corps Center The Glenmont Job Corps Center provides students with the opportunity to earn their High School Diploma or Equivalent (GED), and hands-on training in the following areas: Certified Nurse Assistant, Clinical Medical Assistant, Medical Administration Assistant, Patient Care Technician, Plumbing, Painting, Security and Protective...
-
Recreation Advisor
2 weeks ago
Glenmont, United States Adams and Associates, Inc. Full timeAbout Glenmont Job Corps Center The Glenmont Job Corps Center provides students with the opportunity to earn their High School Diploma or Equivalent (GED), and hands-on training in the following areas: Certified Nurse Assistant, Clinical Medical Assistant, Medical Administration Assistant, Patient Care Technician, Plumbing, Painting, Security and...