Nursing Jobs in Penfield, NY
$81,307 - $109,761 / year
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 URCD 215 Compensation Range: $81,307.00 - $109,761.00 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: Works collaboratively with various departments across the entire health care system to review clinical documentation, utilizing evidence based criteria to support medical necessity and appropriate level of patient care for services provided. Reports outcome trends and patterns to UM leadership to help identify educational opportunities and performance improvement initiatives across the health care continuum. Adapts to process changes and assists with education efforts that support ongoing improvement. 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. MINIMUM EDUCATION & EXPERIENCE Associate's degree in Nursing and 3 years of acute hospital experience required Bachelor's degree in Nursing (BSN) preferred Or equivalent combination of education and experience Utilization Management experience preferred KNOWLEDGE, SKILLS AND ABILITIES Database experience including: Interqual, Sharepoint, eRecord, ePARC, Cobius preferred LICENSES AND CERTIFICATIONS RN - Registered Nurse - State Licensure and/or Compact State Licensure NYS Registered Nurse license upon hire required 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. $84,557 - $118,380 / year
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: 500295 Cancer Center SMH Work Shift: UR - Day (United States of America) Range: UR URCB 216 Compensation Range: $84,557.00 - $118,380.00 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: Responsible for the administrative, operational, and financial oversight of commercially available gene- and cell-based therapies introduced for therapeutic use at URMC through the High-Cost Advanced Therapeutics (HCAT) Subcommittee process. Serves as the chair for both the HCAT Executive Steering and HCAT Operations Committees. Coordinates the cross-departmental assessment, implementation, and ongoing tracking of clinical, operational, and financial performance of HCAT-approved therapies. Collaborates with contacts in finance, contracting, department administration, legal, pharmacy, nursing, and medical ethics to ensure successful and financially sustainable FDA-approved gene- and cell-based therapy programs across all relevant clinical areas of the institution. Essential Functions: Serves as the Chair for the HCAT Executive Steering Committee. Prepares quarterly reports summarizing all HCAT activity, including patient enrollment, clinical outcomes, costs, revenues, and new treatment entries approved (with associated business plan metrics). Serves as the Chair for the HCAT Operations Committee to review all HCAT-related activities for new treatment approval, site qualifications, and patient qualifications. Provides both clinical and financial tracking for all HCAT-related activities. Coordinates the HCAT new treatment evaluation process, including assigning five parallel workgroups, ensuring progress towards submission of the product monograph, and organizing the final monograph for submission to relevant committees. Provides monthly updates to relevant stakeholders concerning the status of new treatment evaluation and onboarding progress. Organizes and oversees the timely site qualification and approval process with manufacturers or their designated third parties. Coordinates any necessary subgroups across departments to ensure a smooth and timely site activation once site qualification is approved. Engages UR Communications/PR to develop internal and external communications strategies for HCAT-approved products. Develops a full business plan, including a 5-year proforma for treatments under review by the HCAT Subcommittee, in conjunction with finance, relevant department administrators, pharmacy supply chain, and others. Updates financial projections and overall business plans for HCAT-approved products as actual data becomes available, refining or revising initial projections. Works collaboratively with payer contracting to ensure terms and conditions of all payer contracts are aligned with URMC standards for HCAT-approved products. Ensures accurate, timely post-treatment tracking processes are in place to support financial performance at the individual patient and treatment levels. Maintains quarterly reporting on financial outcomes for all HCAT-approved products. In collaboration with Patient Financial Services, Payer Contracting, and Utilization Review, remains up to date on all coding, billing, and revenue projections for HCAT-approved products and those under consideration for use. Tracks patient activation process and serves as a liaison between clinicians, other departments, and patient/family, as needed. Ensures effective tools are in place to track patients across the qualification, approval, contracting, and activation/treatment phases of care. Ensures an accurate, timely post-treatment tracking process for clinical outcomes/metrics as specified in payer contracts, treatment protocols, or other industry standards. Ensures that all required training and education for HCAT-approved products are completed and documented before treatment is initiated. Ensures all REMS regulatory requirements, as indicated, are being met and documented to ensure full compliance and audit readiness. Facilitates and participates in cellular therapy quality committees and directs quality initiatives. Ensures all requirements, standards, and regulations related to cellular therapies are met, in collaboration with the BMT Quality Manager, to meet hospital and accreditation group quality initiatives and requirements. Manages quality improvement opportunities, maintains data collection to meet program needs, and creates standardization for program development. Monitors the pipeline of cell- and gene-based therapies for therapeutics that may be relevant, through interactions with clinical leads, research teams, and manufacturers, as well as FDA approval decisions and proceedings from symposia and conferences. Serves as a liaison with manufacturers of cell- and gene-based therapies. Fosters effective communication with employees, peers, and leaders. Builds and maintains relationships with internal and external partners, as needed. Manages projects, teams, and work groups related to HCAT therapies. Establishes a service culture to provide a first-rate experience for customers (patients, referring providers, faculty). Ensures that staff across multiple departments receive job training and professional development in cell- and gene-based therapies. Manages the change process. Solves problems and makes effective decisions using data/input from stakeholders. Leads service improvement initiatives in the division. Ensures that senior leadership goals and the hospital's strategic plan are communicated to staff and physicians. Develops and maintains knowledge and competence related to cell- and gene-based therapies through continuing education, conferences, primary literature, liaison activities with peers, peer organizations, and manufacturers, and any other means necessary. Other duties as assigned. Minimum Education & Experience: Master's degree in Nursing and 3 years of relevant experience in clinical practice required. Or equivalent combination of education and experience. 2 years of experience in business planning, administration, or fiscal and resource management preferred. Knowledge, Skills & Abilities: Excellent project management skills, including collaborations across multiple departments preferred. Strong independent leadership skills preferred. Licenses and Certifications: RN Licensure in NYS required upon hire. 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.