RN, Utilization Management Job at University of Rochester (Rochester)

Job Description

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.

Job Responsibility

Works collaboratively with various departments across the entire health care system to review clinical documentation, utilizing evidence based criteria to support medical necessity and appropriate level of patient care for services provided
Reviews outcome trends and patterns to identify educational opportunities and performance improvement processes across the health care continuum
Responsible for auditing the quality of clinical documentation and providing education based on findings
Determines level of care per regulatory requirements
Provides level of care notifications to patients and families as needed
Works collaboratively with payers to ensure authorization for dates of service
Collaborates with HIM, providers, Financial Counseling and Patient Financial Services
Monitors all UM hold bills and unplanned readmission reports
Conducts initial and concurrent reviews, utilizing evidence based criteria through Interqual
Supports discharge appeal process
Responsible for departmental denials and appeal activity
Documents according to regulatory guidelines and UM RN workflow protocols
Conducts clinical documentation improvement efforts through query process
Meets productivity expectations established by UM department
Provides and supports ongoing educational needs for all UM customers
Other duties as assigned

Requirements

Associate's degree in Nursing and 3 years of acute hospital experience required
Bachelor's degree preferred
Or equivalent combination of education and experience
Utilization Management experience preferred
Database experience including: Interqual, Sharepoint, eRecord, ePARC, Cobius preferred
RN - Registered Nurse - State Licensure and/or Compact State Licensure NYS Registered Nurse license upon hire required

Nice to have

Bachelor's degree preferred
Utilization Management experience preferred
Database experience including: Interqual, Sharepoint, eRecord, ePARC, Cobius preferred

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RN, Utilization Management

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