Current jobs related to Clinical Utilization Review Specialist - Schenectady, New York - Albany Medical Center

  • Clinical Care Specialist

    3 weeks ago

    Schenectady, New York, United States DirectEmployers Full time

    Job Summary:DirectEmployers is seeking a skilled Clinical Care Specialist to join our team. As a Clinical Care Specialist, you will be responsible for providing high-quality patient care in the acute care setting.Key Responsibilities:Evaluate patient assessment data and establish nursing diagnoses.Develop individualized patient care plans based on patient...

  • Medical Assistant

    3 weeks ago

    Schenectady, New York, United States Community Care Physicians Full time

    Medical Assistant - Clinical Support SpecialistCommunity Care Physicians is seeking a skilled Medical Assistant to provide clinical support in our Niskayuna office. As a key member of our healthcare team, you will be responsible for:Documenting patient information and maintaining accurate recordsMaintaining patient flow and preparing patients for...

  • Clinical Specialist

    3 weeks ago

    Schenectady, New York, United States Northern Rivers Family of Services Full time

    Job SummaryAs a Clinician, Prevention at Northern Rivers Family of Services, you will play a vital role in providing comprehensive clinical, case planning, and family support services to county residents. We are dedicated to helping parents, caregivers, and children succeed by drawing on their natural strengths while addressing the risks that impact safety,...

  • Diagnostic Imaging Specialist

    3 weeks ago

    Schenectady, New York, United States Ellis Medicine Full time

    Job Summary: We are seeking a highly skilled Diagnostic Imaging Specialist to join our team at Ellis Medicine. As a Diagnostic Imaging Specialist, you will be responsible for performing diagnostic ultrasounds in various areas, including abdominal, OB/GYN, vascular, small parts, and breast.Key Responsibilities:Perform high-quality sonographic images and...

  • Diagnostic Imaging Specialist

    3 weeks ago

    Schenectady, New York, United States Ellis Medicine Full time

    Diagnostic Imaging SpecialistAt Ellis Medicine, we are seeking a skilled Diagnostic Imaging Specialist to join our team. As a Diagnostic Imaging Specialist, you will be responsible for performing diagnostic ultrasounds in various areas, including abdominal, OB/GYN, vascular, small parts, and breast. You will utilize your clinical and technical knowledge to...

  • Dietitian - Clinical Nutrition Specialist

    4 weeks ago

    Schenectady, New York, United States Unidine Full time

    Job SummaryWe are seeking a highly skilled Clinical Dietitian to join our Nutrition Team in a Senior Living Community in Schenectady, NY.Key Responsibilities:Provide medical nutrition therapy, including nutrition assessment, diet modification, nutrition education, and intervention for the patient population.Follow all guidelines as outlined within the...

  • Software Support Specialist

    3 weeks ago

    Schenectady, New York, United States Transfinder Full time

    Job Title: Software Support SpecialistThis is a remote position.Software Support Specialist (2 Openings) Pay Status and Classifications: Exempt, Regular Full Time Supervisor Title: Support Services Manager Work location: Remote in New York or Texas. If in New York and local to company headquarters there are days the Software Support Specialist...

  • Roofing Specialist

    3 weeks ago

    Schenectady, New York, United States Hancock Claims Consultants Technicians Full time

    Job OverviewHancock Claims Consultants Technicians is seeking a skilled Roofing Specialist to join our dynamic field team. As a Roofing Specialist, you will be responsible for conducting thorough inspections of residential and commercial properties to assess damage and identify areas for repair.Key Responsibilities:Conduct roof inspections to identify damage...

  • Environmental Conservation Specialist

    2 weeks ago

    Schenectady, New York, United States New York State Civil Service Full time

    Job Title: Environmental Conservation SpecialistDescription: We are seeking a highly skilled Environmental Conservation Specialist to join our team at the New York State Department of Environmental Conservation. The successful candidate will be responsible for implementing and assisting with various activities at the regional level in the Division of Water,...

  • Pharmacy Specialist

    4 weeks ago

    Schenectady, New York, United States MVP Health Care Full time

    About the RoleWe are seeking a highly skilled and detail-oriented Pharmacy Specialist to join our team at MVP Health Care. As a key member of our pharmacy department, you will play a critical role in ensuring the smooth operation of our daily pharmacy functions.Key ResponsibilitiesManage incoming faxes requesting drug coverage and determine...

  • Declassification Specialist

    3 weeks ago

    Schenectady, New York, United States Marathon TS Full time

    Job Title: Declassification SpecialistAbout the Role:Marathon TS is seeking a skilled Declassification Specialist to support a client in the field of nuclear propulsion. As a key member of our team, you will be responsible for reviewing technical program records in accordance with Executive Order 13526, as amended. Responsibilities:Review and analyze...

  • IT Operations Specialist

    4 weeks ago

    Schenectady, New York, United States The Golub Corporation - Price Chopper Supermarkets Full time

    The IT Operations Specialist will be responsible for data entry, scanning, and Mainframe related production printing. Key responsibilities include managing multiple tasks, utilizing various office equipment, and ensuring accurate data entry. This role requires attention to detail and the ability to work independently. The ideal candidate will have experience...

  • Case Manager

    4 weeks ago

    Schenectady, New York, United States Living Resources Full time

    Job Title: Case Manager - Day Habilitation SpecialistLiving Resources is a non-profit human services agency dedicated to supporting individuals with disabilities or life-challenging conditions. We are seeking a skilled Case Manager - Day Habilitation Specialist to join our team in Schenectady County.Job Summary:The Case Manager - Day Habilitation Specialist...

  • Medical Coder Specialist

    2 weeks ago

    Schenectady, New York, United States Ellis Medicine Full time

    **Job Summary:**We are seeking a highly skilled Clinical Coding Specialist to join our team at Ellis Medicine. As a Clinical Coding Specialist, you will be responsible for managing charge entry and charge reconciliation for assigned physician practices.**Key Responsibilities:**Manage the charge entry and charge reconciliation process for assigned...

  • Clinical Nurse Specialist

    4 weeks ago

    Schenectady, New York, United States Albany Medical Center Full time

    Clinical Opportunities at Albany Medical Center **Job Summary** As a Clinical Nurse at Albany Medical Center, you will play a vital role in delivering high-quality patient care. Your responsibilities will include administering medications and treatments, starting IVs, and performing special tests as directed by physicians. You will also be responsible for...

  • Accounting Specialist

    2 weeks ago

    Schenectady, New York, United States Schenectady ARC Full time

    We are seeking a skilled Accounting Specialist to join our team. Key responsibilities include:Preparation and review of financial statements.Compliance with accounting standards and regulations.Financial data analysis and interpretation.A degree in accounting or finance is required, with a minimum of 2 years of experience in a similar role. If you have a...

  • Nursing Education Specialist

    2 weeks ago

    Schenectady, New York, United States Ellis Medicine Full time

    About Ellis MedicineEllis Medicine is a leading healthcare provider committed to delivering exceptional patient care and fostering a diverse environment. We are proud to be an equal-opportunity employer, dedicated to creating a workplace that values inclusivity and respect.Salary RangeThe salary for this role is $50 per hour, commensurate with experience,...

  • Clinical Risk Assessment Nurse

    7 days ago

    Schenectady, New York, United States Mvp Health Plan Inc Full time

    About the Role:This is an exciting opportunity for a Clinical Nurse to join our Underwriting team as a Medical Underwriting Nurse. As a key member of our team, you will be responsible for analyzing medical and pharmacy utilization reports to assist in predicting future claim costs.

  • Clinical Therapist

    4 weeks ago

    Schenectady, New York, United States Northern Rivers Family of Services Full time

    Job Title: Clinician/Social Worker, Fee-for-Service Job Summary: We are seeking a skilled Clinician/Social Worker to join our team at Northern Rivers Family of Services. As a Clinician, you will work with underserved populations in our community, providing clinical counseling to individuals, families, and couples in an outpatient mental health...

  • Clinical Nurse Specialist

    4 weeks ago

    Schenectady, New York, United States Albany Medical Center Full time

    Job SummaryWe are seeking a highly skilled Clinical Nurse II to join our Medical/Surgical team at Albany Medical Center. As a Clinical Nurse II, you will play a vital role in providing exceptional patient care and contributing to the creation of a compassionate and caring environment for patients, families, and colleagues.Key ResponsibilitiesImplement...

Clinical Utilization Review Specialist

2 months ago

Schenectady, New York, United States Albany Medical Center Full time
Job Summary

We are seeking a skilled Utilization Review Nurse 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 efficient and effective delivery of patient care.

Key Responsibilities
  • Conduct thorough utilization reviews to identify opportunities for improvement in patient care and resource utilization.
  • Apply MCG criteria to monitor the appropriateness of admissions and continued stays, and document findings in accordance with departmental standards.
  • Collaborate with healthcare teams to identify areas for clinical documentation improvement and implement changes as needed.
  • Utilize approved screening tools to identify at-risk populations and develop strategies for improvement.
  • 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.
  • Facilitate the removal of delays and document delays when they exist, reporting to the Triad Team as needed.
Requirements
  • 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.
  • Assertive and creative problem-solving skills, with the ability to adapt in a changing environment.
  • Basic knowledge of computer systems and skills applicable to utilization review process.
  • Excellent written and verbal communication skills.
  • Working knowledge of MCG criteria and ability to implement and utilize.
About Albany Medical Center

Albany Medical Center is an equal opportunity employer committed to providing a work environment that is free from discrimination and harassment. We are dedicated to fostering a culture of diversity, equity, and inclusion, and we welcome applications from qualified candidates from diverse backgrounds.