Job Description

Join Our Team at Albany Medical Center!

Are you ready to make a difference in patient care? We are seeking a dedicated professional to join our Care Management/Social Work team in Auriesville, NY. This is your chance to play a vital role in Utilization Management, Quality Screening, and Delay Management for our patients.

About the Role

As a key member of our team, you will:

• Conduct Utilization Management and Quality Screening for assigned patients, ensuring the highest standards of care.
• Apply MCG criteria to monitor the appropriateness of admissions and continued stays, documenting findings in line with departmental standards.
• Identify areas for clinical documentation improvement and collaborate with the appropriate departments.
• Monitor Length of Stay (LOS) and resource use, taking proactive steps for continuous improvement.
• Communicate with the Medical Director and Triad Team regarding cases and follow up as necessary.
• Discuss payor criteria with clinical staff on a case-by-case basis to resolve any issues.
• Utilize quality screens to identify potential issues and forward findings to the Quality Department.
• Facilitate the removal of delays in patient care and document any existing delays.
• Collaborate with the healthcare team to ensure seamless management of care across the continuum.

What We’re Looking For

To thrive in this role, you should meet the following qualifications:

• Current New York State RN License
• Bachelor’s degree preferred
• Minimum of three years clinical experience in a relevant service area
• Experience in case management, utilization management, or discharge planning in a high-volume acute care hospital is preferred
• Case Management certification is a plus
• Strong problem-solving and critical thinking skills
• Self-directed with the ability to adapt in a dynamic environment
• Basic computer skills relevant to the utilization review process
• Excellent communication skills , both written and verbal
• Familiarity with MCG criteria and the ability to implement them effectively
• Understanding of inpatient vs. outpatient surgery and ICD10 coding is preferred
• Strong organizational and time management skills
• Knowledge of Medicare regulatory requirements and Managed Care Plans

Why Join Us?

At Albany Medical Center, we value our employees and offer:

• Competitive Salary: $71,612.39 - $110,999.20
• Flexible Work Shifts: Day shifts available
• Growth Opportunities: We support your professional development and career advancement
• Inclusive Environment: We are an equal opportunity employer committed to diversity

Thank you for considering a career with Albany Medical Center! We look forward to welcoming you to our team.

Please note: This role may require access to sensitive information, including HIPAA Protected Health Information. We expect all workforce members to adhere to our policies regarding information access and protection.

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