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RN, Utilization Management

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University of Rochester

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Location:
United States of America , Rochester

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Category:
Nursing

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Contract Type:
Not provided

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Salary:

80923.00 - 105208.00 USD / Year
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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

Additional Information:

Job Posted:
March 10, 2026

Employment Type:
Fulltime
Work Type:
Hybrid work
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