Job Description

Join Our Team at Albany Medical Center!

Are you ready to make a meaningful impact in healthcare? We are seeking a dedicated professional to join our Care Management/Social Work department in beautiful Castleton On Hudson, NY . This is your chance to be part of a dynamic team focused on improving patient care!

Position Overview

As a key player in our team, you will be responsible for Utilization Management, Quality Screening, and Delay Management for assigned patients. Your expertise will help ensure that our patients receive the best possible care.

Your Responsibilities

• Conduct Utilization Management and Quality Screening for assigned patients.
• Apply MCG criteria to assess the appropriateness of admissions and continued stays, documenting findings according to 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.
• Refer cases to the Medical Director and Triad Team as needed, ensuring compliance with departmental procedures.
• Communicate reimbursement certification for assigned patients and resolve payor issues with clinical staff.
• Utilize quality screens to identify potential issues and forward information to the Quality Department.
• Facilitate the removal of delays and document any existing delays, reporting them to the Triad Team.
• Collaborate with the healthcare team to manage care across the continuum, ensuring effective communication.

What We’re Looking For

• Qualifications: Registered nurse with a current New York State license.
• Education: Bachelor’s degree preferred.
• Experience: Minimum of three years in clinical settings, with recent experience in case management, utilization management, or discharge planning in a high-volume acute care hospital preferred.
• Certifications: Case Management certification preferred.
• Skills: Strong problem-solving abilities, critical thinking, and adaptability in a changing environment.
• Basic computer skills relevant to the utilization review process.
• Excellent written and verbal communication skills.
• Familiarity with MCG criteria and understanding of inpatient vs. outpatient surgery and ICD10 coding preferred.
• Strong organizational and time management skills.
• Knowledge of Medicare regulatory requirements and Managed Care Plans.

Why Join Us?

• Competitive Salary: Enjoy a salary range of $71,612.39 - $110,999.20 .
• Growth Opportunities: We believe in investing in our team members and providing opportunities for professional development.
• Supportive Environment: Work alongside a passionate team dedicated to improving patient outcomes.
• Flexible Work Conditions: Day shifts that allow for a balanced work-life experience.

Thank you for considering a career with Albany Medical Center! We are proud to be an equal opportunity employer and welcome applicants from all backgrounds.

Please note that 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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