Weekday Cvs Utilization Management Nurse Jobs in Rochester, NY

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 Location (Full Address):

601 Elmwood Ave, Rochester, New York, United States of America, 14642

Opening:

Worker Subtype:

Regular

Time Type:

Full time

Scheduled Weekly Hours:

40

Department:

500009 Utilization Management

Work Shift:

UR - Day (United States of America)

Range:

UR URCD 215

Compensation Range:

$81,307.00 - $109,761.00

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

Responsibilities:

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. Reports outcome trends and patterns to UM leadership to help identify educational opportunities and performance improvement initiatives across the health care continuum. Adapts to process changes and assists with education efforts that support ongoing improvement.

ESSENTIAL FUNCTIONS

• 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.

MINIMUM EDUCATION & EXPERIENCE

• Associate's degree in Nursing and 3 years of acute hospital experience required

• Bachelor's degree in Nursing (BSN) preferred

• Or equivalent combination of education and experience

• Utilization Management experience preferred

KNOWLEDGE, SKILLS AND ABILITIES

• Database experience including: Interqual, Sharepoint, eRecord, ePARC, Cobius preferred

LICENSES AND CERTIFICATIONS

• RN - Registered Nurse - State Licensure and/or Compact State Licensure NYS Registered Nurse license upon hire required

The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University’s Mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.

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Learn. Discover. Heal. Create.

Located in western New York, Rochester is our namesake and our home. One of the world’s leading research universities, Rochester has a long tradition of breaking boundaries—always pushing and questioning, learning and unlearning. We transform ideas into enterprises that create value and make the world ever better.

If you’re looking for a career in higher education or health care, the University of Rochester may offer the perfect opportunity for your background and goals.

At the University of Rochester, we are committed to fostering, cultivating, and preserving an inclusive and welcoming culture and are united by a strong commitment to be ever better—Meliora. It is an ideal that informs our shared mission to ensure all members of our community feel safe, respected, included, and valued.