Utilization Review Specialist - RN at Rochester Regional Health Job Listing at DirectEmployers in Rochester, NY (Job ID 3997475-2024-07-24)

Description

Description

SUMMARY

As a Registered Nurse - Utilization Review Specialist, your strong attention to detail, knowledge of regulations and exceptional evaluation skills lead you to accurately determine necessary levels of care, reducing denials and increasing compliance.

STATUS:

LOCATION:

DEPARTMENT:

SCHEDULE:

ATTRIBUTES

• Three (3) years of acute hospital care, case management or utilization management experience
• Knowledge of federal and state regulations (DOH, Medicaid/Medicare)
• Knowledge of third party payor and/or managed care payment principles helpful
• Excellent communication and interpersonal skills
• Strong understanding of medical management techniques and processes
• Strong organizational and problem-solving skills
• Ability to adapt and be flexible to changes based on health system needs

RESPONSIBILITIES

• Level of Care Management. Use nationally recognized standards of care guidelines to evaluate hospital admissions and assure the level of care is medically necessary and at the most appropriate level; concurrently monitor resource utilization, perform continued stay reviews and assist with managing the length of stay across the continuum; analyze utilization and quality trends and make recommendations to management on improvement opportunities
• Documentation & Referral. Document level of care in the clinical review note to support determination; appropriately identify and refer cases to the Physician Advisor/EHR, in order to validate level of care based on medical necessity

PHYSICAL REQUIREMENTS: M - Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects; Requires frequent walking, standing or squatting.

LICENSES/CERTIFICATIONS:

• BLS - Basic Life Support - American Heart Association (AHA)
• RN - Registered Nurse - New York State Education Department (NYSED)

PAY RANGE: $76,500.00 - $105,000.00

The listed base pay range is a good faith representation of current potential base pay for successful applicants. It may be modified in the future. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity / Affirmative Action Employer. Minority/Female/Disability/Veteran

Compensation Information:
$76500.0 / Yearly - $76500.0 / Yearly

Starting At: 76500.0 Yearly
Up To: 105000.0 Yearly

 Apply on company website