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 URCB 213 Compensation Range: $69,326.00 - $90,124.00 _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:** GENERAL PURPOSE: The Utilization Management Nurse role is a unique and exciting opportunity that blends the knowledge of nursing and the business aspects of the healthcare system. The position spans the entire healthcare system working collaboratively with Health Information Management, Financial Counselors, Patient Financial Services, Physicians, Social Work, patients, and various insurance companies. The UM RN is responsible for the review of clinical documentation utilizing evidence-based criteria to support medical necessity and appropriate level of patient care for services provided. The UM RN is also responsible for reviewing outcome trends and patterns to identify educational opportunities and performance improvement processes across the healthcare continuum. The role requires strong communication skills and critical thinking skills. Primarily Monday through Friday with occasional off-shift and weekend commitments depending on the needs of the department. The majority of work is remote with some on-site requirements as needed. **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. **QUALIFICATIONS** + RN with Utilization Review experience preferred; 3-5 years of recent acute hospital experience required. **EOE Minorities / Females / Protected Veterans / Disabled:** The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion 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 status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations. Notice: If you are a **Current** **Employee,** please **log into myURHR** to search for and apply to jobs using the Jobs Hub. Your application, if submitted using this portal, cannot be moved forward. **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 commit to diversity, equity, and inclusion and 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.