Job Description

Join Our Team at Albany Medical Center!

Are you ready to make a difference in patient care? We are looking for a dedicated professional to join our Care Management/Social Work team in beautiful Spencertown, NY. This is your chance to contribute to Utilization Management, Quality Screening, and Delay Management for our valued patients.

Position Overview

As a key member of our team, you will be responsible for:

• Conducting Utilization Management and Quality Screening for assigned patients.
• Applying MCG criteria to ensure appropriate admissions and continued stays, while documenting findings according to departmental standards.
• Identifying areas for clinical documentation improvement and collaborating with the appropriate departments.
• Monitoring Length of Stay (LOS) and ancillary resource use, driving continuous improvement.
• Referring cases to the Medical Director and Triad Team, ensuring compliance with departmental procedures.
• Communicating reimbursement certifications and resolving payor issues with clinical staff.
• Utilizing quality screens to identify potential issues and forwarding information to the Quality Department.
• Facilitating the removal of delays and documenting any that occur.
• Collaborating with the healthcare team to manage care across the continuum.

What We’re Looking For

To thrive in this role, you should have:

• A current Registered Nurse license in New York State.
• A Bachelor’s degree (preferred).
• A minimum of three years of clinical experience in an assigned service.
• Recent experience in case management, utilization management, or discharge planning in a high-volume acute care hospital (preferred).
• Case Management certification (preferred).
• Strong problem-solving skills and critical thinking abilities.
• Self-direction and adaptability in a dynamic environment.
• Basic computer skills relevant to the utilization review process.
• Excellent written and verbal communication skills.
• Familiarity with MCG criteria and the ability to implement them effectively.
• Understanding of inpatient vs. outpatient surgery, ICD10 coding (preferred), and observation status qualifications.
• Strong organizational and time management skills.
• Analytical skills and proficiency in data management.
• Knowledge of Medicare regulatory requirements and Managed Care Plans.

Why Join Us?

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

• A competitive salary range of $71,612.39 - $110,999.20.
• A supportive and collaborative work environment.
• Opportunities for professional growth and development.
• A commitment to diversity and inclusion as an equal opportunity employer.

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. All workforce members are expected to adhere to strict confidentiality and data protection standards.

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