Utilization Review

Rochester Regional Health | Rochester, NY

Posted Date 9/13/2022
Description

SUMMARY

As a Care Facilitator, your analysis of and attention to the care plan are key contributors to ensuring patient needs are met and delivery of care is optimal.

STATUS: Full Time

LOCATION: Unity Hospital

DEPARTMENT: Care Management

SCHEDULE: Days

ATTRIBUTES

  • If not already attained, in active pursuit of a BSN from an accredited school, and/or comparable clinical experience
  • Minimum five (5) to eight (8) years clinical experience; case management/utilization management/discharge planning experience preferred
  • Patient focused, organized and excellent communication skills

RESPONSIBILITIES

  • Evaluation & Care Management. Conduct clinical reviews utilizing objective criteria to assign patient to the appropriate level of care; identify clinical resources required to achieve optimal patient outcomes and appropriate reimbursement; monitor resource utilization, perform continued stay reviews and assist with managing the length of stay of patients; refer cases to the Review Physician Advisor to validate level of care; communicate clinical information to payors
  • Documentation. Document level of care and medical necessity in the Care Management database to support the clinical review process
  • Leadership & Communication. Work with Care Management Leadership to identify problems, recommend solutions and work toward resolution; utilize data, trends and reports to proactively identify opportunities to improve processes and practice; function as a resource to healthcare team for payor requirements, ensuring optimal use of patient healthcare benefits; foster relationships with payors and facilitate communication between hospital and payor as appropriate 
Employment Type
Full Time

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