Utilization Review Specialist - RN

Utilization Review Specialist - RNRochester, New YorkApply Now (Save JobOverviewResponsibilitiesBenefitsTestimonialsCareer PathVideoLocationOverviewAt Rochester Regional Health, we know that delivering the best care means empowering nurses throughout every stage of their career. Weve created a unique environment that fosters professional development and personal growth for our team members including a clinical ladder, competitive pay and benefits, and support for continuing education. Its our way of investing in those who care.Back to Job Navigation (Overview)ResponsibilitiesJob IDREQ_152896 FACILITYRochester General Hospital LOCATIONRochester, New York View More of this Job Description SUMMARYAs 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 TimeDEPARTMENT: Utilization ReviewSCHEDULE: D/E, 1 weekend every 4th week, 2 holidays/yearATTRIBUTESThree (3) years of acute hospital care, case management or utilization management experienceKnowledge of federal and state regulations (DOH, Medicaid/Medicare)Knowledge of third party payor and/or managed care payment principles helpfulExcellent communication and interpersonal skillsStrong understanding of medical management techniques and processesStrong organizational and problem-solving skillsAbility to adapt and be flexible to changes based on health system needsRESPONSIBILITIESLevel 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 opportunitiesDocumentation & 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 necessityLICENSES/CERTIFICATIONSBLS - Basic Life Support - American Heart Association (AHA); RN - Registered Nurse - New York State Education Department (NYSED) Rochester Regional Health is an Equal Opportunity / Affirmative Action Employer. Minority/Female/Disability/VeteranApply Now (Helping you succeedDiscover all the ways Rochester Regional Health supports your professional development and personal growth.Clinical LadderNurses who advance on our clinical ladder receive a promotion at the bedside through growth in their skillset, a new title and monetary recognition up to $3.00/hourRapid Pay IncreasesReceive rapid pay increases every six months during the first two years of employment, and annual increases thereafter.Unlimited CertificationsNurses earn up to an additional $1.00/hour for each certification earned plus a $1,000 bonus for the first certification earned, and $500 for the second certification.I began my healthcare career as a patient care technician while working towards my BSN. Rochester Regional Health offers a variety of opportunities for nurses, and leadership empowers us to fine-tune our interests and passions, while developing a strong clinical practice.Megan Murphy, MSN, RN, BSN Nurse EducatorI am very impressed with the focus and investment on education and professional development thats being developed and implemented at RRH. Investing in staff is what distinguishes a good organization from a great one and Im happy to see that RRH is working hard to distinguish itself as a great regional employer.Benjamin C. Snyder, RN, BSN Nurse ManagerRochester Regional Health has been very supportive and inviting of any opportunities that Ive wanted to explore. The opportunities for growth are truly unlimited. As the chair of the Clinical Ladder Committee, Ive seen first-hand how many nurses take advantage of this and explore opportunities for their own growth and advancement.Kaitlin Costello, RN, BSN, CEN, TCRN Clinical Nurse LeaderFind Your WayAt Rochester Regional Health, empowering our nurses as they build their careers is our top priority. If youre looking to make a change, learn more about how we can help you build a successful and fulfilling nursing career.Based on your preferences and skill sets, youll have the opportunity to pursue the nursing career path that interests you most.bedside nursingclinical educationnursing leadershipoperationsbedside nursingDeepen your knowledge as a specialist within the expansive specialty unit that you are most passionate about, including:Acute MedicineCardiologyCritical CareNeuro/StrokeOncologyPediatricsSurgicalKaitlin Costello, RN, BSN, CEN, TCRN Clinical Nurse LeaderClinical EducationHelp others broaden their skills and proficiencies as a:PreceptorClinical Nurse SpecialistClinical Resource NurseNurse EducatorMegan Murphy, MSN, RN, BSN Nurse EducatorNursing LeadershipLead the way for other nurses with positions that include:Charge NurseClinical Nurse LeaderNurse ManagerNurse DirectorAssociate CNOCNOKristen Oppet, RN, BS, MSHA Vice President, Chief Nursing OfficerOperationsTake care of every person at every level by joining departments that require your expertise including:Call CenterCare ManagementClinical InformaticsInfection PreventionNurse Recruitment (HR)Patient Safety & QualityPerformance ImprovementUtilization ReviewChelsea E. Reff, MBA, RN-BC, BSN Nurse Compensation Manager,Rochester Regional HealthWe are nurses growing together

Created: 2025-11-15