Description

　　HOW WE CARE FOR YOU:

　　At Rochester Regional Health, we are dedicated to getting healthcare right. Our robust benefits and total rewards foster employee wellbeing, professional development and personal growth. We care for your career while caring for the community.

　　Health & Wellness Benefits starting Your First Day

　　Personal Time that includes Vacation Time, Sick Time & Holidays

　　Retirement Savings Program

　　Same Day Pay through DailyPay

　　Student Loan Repayment Program

　　Tuition Assistance & Reimbursement

　　Free Parking

　　SUMMARY

　　As a Registered Nurse (RN) - Utilization Review, 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: Full Time

　　LOCATION: Rochester General Hospital

　　DEPARTMENT: Utilization Review

　　SCHEDULE: Monday - Friday, Days

　　ATTRIBUTES

　　Diploma or Associate's Degree in Nursing required; Bachelor's Degree in Nursing preferred.

　　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:

　　RN - Registered Nurse - New York State Education Department (NYSED)BLS - Basic Life Support - American Heart Association (AHA)PAY RANGE: $33.00 - $48.00

　　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

　　Minimum Salary: 33.00Maximum Salary: 48.00Salary Unit: Hourly