Utilization Review Specialist - RN (rrhs)

Job Description

HOW WE CARE FOR YOU

At Rochester Regional Health, we are dedicated to getting health care 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.

• Sign-On Bonuses for external experienced RN’s
• Same Day Pay through DailyPay
• Acute Care Department Premium
• Paid Vacation & Holidays
• Clinical Ladder
• Certification Pay
• Shift Differentials
• Relocation Assistance
• Benefits Effective Date of Hire
• Tuition & Loan Assistance  
• Employee Referral Program
• Free Parking

Job Title: Utilization Review RN

Department: Utilization Review

Location: Rochester General Hospital

Hours Per Week: Full Time/40 hours

Schedule: Days (8am-4:30pm or 8:30am-5pm)

SUMMARY:

As a Registered Nurse (RN), you are the engine and the heart of patient care at Rochester Regional Health. You make a positive difference every single day in the lives of our patients, their family members and visitors – going above and beyond to meet their needs with courtesy, kindness, respect and compassion. 

The Cardiac Cath/Electrophysiology Lab performs tests to assess a heart's electrical system or activity and is used to diagnose abnormal heartbeats or arrhythmia. The test is performed by inserting catheters and then wire electrodes, which measure electrical activity, through blood vessels that enter the heart.

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

REQUIRED QUALIFICATIONS:

• Diploma or Associates Degree in Nursing
• Registered Nurse license in New York State
• Excellent oral and written communication and interpersonal skills
• Good understanding of medical management techniques and processes
• Strong organizational and problem solving skills
• Able to adapt and be flexible to changes based on health system needs

PREFERRED QUALIFICATIONS

• Bachelor's Degree in Nursing
• 3 years of acute hospital care, Case Management or Utilization Management experience is highly preferred
• Knowledge of federal and state regulations (DOH, Medicaid/Medicare)
• Knowledge of third party pay or and/or managed care payment principles helpful
• Case Management Certification

EDUCATION:

BS (Required)

LICENSES / CERTIFICATIONS: 

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

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.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.

PAY RANGE:

$74,900.00 - $107,000.00Rochester14621-3038

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. 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/Veterans by a prospective employee and/or employee’s Physician or delegate will be considered for accommodations.