Registered Nurse - Utilization Review Specialist
Company: Rochester General Health System
Location: Rochester
Posted on: January 26, 2023
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Job 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: Full Time
LOCATION: Rochester General Hospital
DEPARTMENT: Physician Advisor / Utilization Review
SCHEDULE: Currently Monday - Friday, Days with potential
Days / Evenings, Every 4th weekend, Holidays (weekends, evenings
and holidays currently on hold)
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
Keywords: Rochester General Health System, Rochester , Registered Nurse - Utilization Review Specialist, Healthcare , Rochester, New York
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