Clinical Utilization Review Specialist

  • Schenectady
  • Albany Medical Center
Job Summary

We are seeking a skilled Clinical Utilization Review Specialist to join our team at Albany Medical Center. As a key member of our Care Management 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.
  • Collaborate with healthcare teams to develop and implement effective care plans that meet the needs of patients and families.
  • Communicate with payors and other stakeholders to resolve issues and ensure seamless care transitions.
  • Monitor and analyze data to identify trends and areas for improvement in patient care and resource utilization.
  • Develop and maintain relationships with healthcare providers and payors to ensure optimal care delivery and reimbursement.
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.
What We Offer

Albany Medical Center is an equal opportunity employer and offers a competitive salary and benefits package. If you are a motivated and detail-oriented individual with a passion for delivering high-quality patient care, we encourage you to apply for this exciting opportunity.