Utilization Review Specialist - RN

Utilization Review Specialist - RN

Rochester Regional Health | Rochester, NY, 14651, US
Salary Range:$72,000 – $93,000 Salary range estimated by Zippia

Posted a month ago

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Utilization Review Specialist - RN

Rochester, New York

Apply Now (https://rrhs.wd5.myworkdayjobs.com/RRH/job/Rochester-General-Hospital/Utilization-Review-Specialist---RN\_REQ\_152896/apply) Save Job

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At Rochester Regional Health, we know that delivering the best care means empowering nurses throughout every stage of their career. We've 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. It's our way of investing in those who care.

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Job IDREQ_152896 FACILITYRochester General Hospital LOCATIONRochester, New York

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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

DEPARTMENT: Utilization Review

SCHEDULE: D/E, 1 weekend every 4th week, 2 holidays/year


+ 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


+ 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

LICENSES/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/Veteran

Apply Now (https://rrhs.wd5.myworkdayjobs.com/RRH/job/Rochester-General-Hospital/Utilization-Review-Specialist---RN\_REQ\_152896/apply)

Helping you succeed

Discover all the ways Rochester Regional Health supports your professional development and personal growth.

Clinical Ladder

Nurses 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/hour

Rapid Pay Increases

Receive rapid pay increases every six months during the first two years of employment, and annual increases thereafter.

Unlimited Certifications

Nurses 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 Educator

I am very impressed with the focus and investment on education and professional development that's being developed and implemented at RRH. Investing in staff is what distinguishes a good organization from a great one and I'm happy to see that RRH is working hard to distinguish itself as a great regional employer.

Benjamin C. Snyder, RN, BSN Nurse Manager

Rochester Regional Health has been very supportive and inviting of any opportunities that I've wanted to explore. The opportunities for growth are truly unlimited. As the chair of the Clinical Ladder Committee, I've 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 Leader

Find Your Way

At Rochester Regional Health, empowering our nurses as they build their careers is our top priority. If you're 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, you'll have the opportunity to pursue the nursing career path that interests you most.

+ bedside nursing

+ clinical education

+ nursing leadership

+ operations

bedside nursing

Deepen your knowledge as a specialist within the expansive specialty unit that you are most passionate about, including:

+ Acute Medicine

+ Cardiology

+ Critical Care

+ Neuro/Stroke

+ Oncology

+ Pediatrics

+ Surgical

Kaitlin Costello, RN, BSN, CEN, TCRN Clinical Nurse Leader

Clinical Education

Help others broaden their skills and proficiencies as a:

+ Preceptor

+ Clinical Nurse Specialist

+ Clinical Resource Nurse

+ Nurse Educator

Megan Murphy, MSN, RN, BSN Nurse Educator

Nursing Leadership

Lead the way for other nurses with positions that include:

+ Charge Nurse

+ Clinical Nurse Leader

+ Nurse Manager

+ Nurse Director

+ Associate CNO


Kristen Oppet, RN, BS, MSHA Vice President, Chief Nursing Officer


Take care of every person at every level by joining departments that require your expertise including:

+ Call Center

+ Care Management

+ Clinical Informatics

+ Infection Prevention

+ Nurse Recruitment (HR)

+ Patient Safety & Quality

+ Performance Improvement

+ Utilization Review

Chelsea E. Reff, MBA, RN-BC, BSN Nurse Compensation Manager,

Rochester Regional Health

We are nurses growing together