Utilization and Quality Review Specialist- RN
Rochester Regional Health

Rochester, New York
$67,500.00 - $90,000.00 per year

This job has expired.



At Rochester Regional Health, we are dedicated to getting health care right. Our robust benefits and total rewards foster employee wellbeing, professional development and personal growth. We care for your career while caring for the community.

  • Health & Wellness Benefits starting Your First Day
  • Medical, Dental & Vision Programs tailored to Your Needs
  • Employee Assistance Program including free Mental Health
  • Access to Life Coaches & Financial Counseling
  • Retirement Savings Programs
  • Employee Referral Program with Bonuses up to $10,000
  • Student Loan Repayment Program
  • Relocation Assistance
  • Free Parking
  • Employee Discount Programs
  • Free ASN to BSN Program through Advance U


Under the direction of Leadership, coordinates/performs all activities related to the RRHS utilization review (UR) program and quality record documentation monitoring. A primary responsibility of this position (in addition to chart review for UR) is the timely review/approval of Start of Care Assessments including the Comprehensive Assessment, Physician Plan of Care, OASIS, and home health diagnosis coding. Reviews clinical documentation to ensure adherence to State and Federal regulations, payer requirements, and OASIS CMS guidance. Provides superior customer service by modeling the Brand Promise and the Core Values.


When you or a loved one is recovering from an illness or injury, home health care can speed healing while also helping you maintain your independence. The Rochester Regional Health Home Care team has provided compassionate, personalized care and assistance for adults and children for more than 50 years, and our quality of care has been among the top-ranked home care groups in the nation.

STATUS: Full time

LOCATION: 330 Monroe Ave, Rochester NY

DEPARTMENT: Home Care and Hospice- Quality Review

SCHEDULE: Monday-Friday, 8am-4:30pm

  • COS-C certification preferred.
  • Home Health Diagnosis Coding Certification preferred.
  • BSN or RN with BS in related field preferred
  • 1 year of home care quality/regulatory experience preferred.
  • 1 year of OASIS experience preferred.
  • Documentation. Responsible for ongoing documentation and chart audit: to include but not limited to home health diagnosis coding, OASIS Start of Care, Resumption of Care, Recertification, and Discharge chart audits, 485 audits, Plan of Corrections audits, compliance audits, etc. Maintaining current knowledge of home health diagnosis coding and OASIS review. Participates in educational opportunities provided to the team. Quarterly Utilization and Review (U/R) process to include timely completion of required number of audits, documentation of audit results.
  • Collaboration. Performs drug regimen reviews as requested by leadership. Performs inter-rater visits as requested by leadership. Collaborates with clinical practice and education nurse to ensure all quality and compliance activities are coordinated and based on data. Performs co-visits or billable patient visits as needed, as requested by leadership.
  • Education. Participates in education of staff to include but not limited to quality initiatives, OASIS in-services, Policy and Procedures, Orientation.
  • BS (Required)
PHYSICAL REQUIREMENTS: M - Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects; Requires frequent walking, standing or squatting.

  • BLS - Basic Life Support - American Heart Association (AHA)
  • RN - Registered Nurse - New York State Education Department (NYSED)
  • NYS DL - valid New York State Driver's License - New York State Department of Motor Vehicles (NYSDMV)
PAY RANGE: $67,500.00 - $90,000.00

The listed base pay range is a good faith representation of current potential base pay for successful applicants. It may be modified in the future. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity / Affirmative Action Employer. Minority/Female/Disability/Veteran

This job has expired.

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