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About the Role
This role involves collaborating with various departments to review clinical documentation, ensuring medical necessity and appropriate patient care levels using evidence-based criteria. The position also focuses on identifying trends, supporting performance improvement initiatives, and adapting to process changes.
Responsibilities
- Determines level of care per regulatory requirements.
- Provides level of care notifications to patients and families.
- 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 using 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.
- Performs other duties as assigned.
Requirements
- Associate's degree in Nursing and 3 years of acute hospital experience required.
- Equivalent combination of education and experience.
- NYS Registered Nurse license upon hire required.
Skills
- Database experience including: Interqual, Sharepoint, eRecord, ePARC, Cobius preferred.
Location
- 601 Elmwood Ave, Rochester, New York, United States of America, 14642
Work Type
- Full time
- Regular
Experience Level
- 3 years of acute hospital experience
Education Level
- Associate's degree in Nursing
- Bachelor's degree in Nursing (BSN) preferred
Salary/Compensations
- $81,307.00 - $109,761.00
About the Company
- 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.
Equal Opportunity
- 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.