Job Description

Join Our Team at Albany Medical Center!

Are you ready to make a meaningful impact in the world of healthcare? We are seeking a dedicated professional to join our Care Management/Social Work team in beautiful Esperance, NY. This is your chance to be part of a dynamic environment where your skills will shine!

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 us ensure the highest standards of care and efficiency.

Your Responsibilities

• Conduct Utilization Management and Quality Screening for assigned patients.
• Apply MCG criteria to monitor 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.
• Utilize approved screening tools to identify at-risk populations and follow established reporting procedures.
• Monitor Length of Stay (LOS) and ancillary resource use, taking proactive steps for continuous improvement.
• Refer cases to the Medical Director and Triad Team, ensuring compliance with departmental procedures.
• Communicate reimbursement certification for assigned patients and resolve payor issues as needed.
• Use quality screens to identify potential issues and collaborate with the Quality Department.
• Facilitate the removal of delays and document any existing delays, reporting them to the Triad Team.
• Work closely 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.
• Bachelor’s degree preferred.
• Minimum of three years of clinical experience in an assigned service.
• 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 skills and critical thinking abilities.
• Self-directed and adaptable in a changing environment.
• Basic computer skills relevant to the utilization review process.
• Excellent written and verbal communication skills.
• Familiarity with MCG criteria and ICD10-Coding is preferred.
• Ability to work independently with strong organizational and time management skills.
• Knowledge of Medicare regulatory requirements and Managed Care Plans.

Why Join Us?

• Competitive Salary: $71,612.39 - $110,999.20
• Growth Opportunities: We believe in nurturing talent and providing pathways for career advancement.
• Flexible Work Environment: Enjoy a supportive atmosphere that values work-life balance.
• Impactful Work: Make a difference in the lives of patients and their families every day.

Thank you for considering a career with Albany Medical Center! We are proud to be an equal opportunity employer, committed to fostering a diverse and inclusive workplace.

Please note that this role may require access to sensitive information, including HIPAA Protected Health Information. We expect all team members to adhere to our policies regarding confidentiality and data protection.

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