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Clinical Utilization Specialist
2 months ago
We are seeking a skilled Utilization Review Nurse to join our Care Management team at Albany Medical Center. As a key member of our team, 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 the appropriateness of admissions and continued stays, and document findings according to departmental standards.
- Identify areas for clinical documentation improvement and work with the team to implement changes.
- Monitor length of stay and ancillary resource use, taking actions to achieve continuous improvement.
- Communicate with payors and healthcare teams 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.
- Case Management certification preferred.
Albany Medical Center is a leading healthcare provider in the Capital Region, dedicated to delivering high-quality patient care and advancing medical research and education.
