Quality Review & Utilization Specialist

Rochester Regional Health; United States; On-site; USD 76,000 - 101,000; Full time

Job summary

Rochester Regional Health is seeking a Quality Review & Utilization Specialist in Home Care (Rochester, NY). The role focuses on improving care quality and appropriate utilization, aligning with department goals.

You will review cases, collaborate with care teams, ensure compliance with regulations, and support evidence-based utilization decisions. Requires BS and listed licenses (BLS, NYS DL, RN). This is a full-time position with standard hours 8:30am-5:00pm, Monday-Friday.

Qualifications

• BS degree required for the role.

Education

BS

Job description

Job Title: Quality Review & Utilization Specialist

DEPARTMENT: Quality Review

LOCATION: Home Care-330 Monroe Ave, Rochester, NY

HOURS: Per Week: 40 Hours

SCHEDULE: 8:30am-5:00pm Monday-Friday

EDUCATION: BS (Required)

LICENSES / CERTIFICATIONS: BLS - Basic Life Support - American Heart Association (AHA), NYS DL - valid New York State Driver's License - New York State Department of Motor Vehicles (NYSDMV), RN - Registered Nurse - NYS Office of Professions

PHYSICAL REQUIREMENTS: Sedentary - Sedentary roles are primarily office-based and require prolonged sitting (67-100% of the workday) with minimal physical effort and lifting limited to under 10 lbs. Fine motor skills are necessary for computer work, writing, and telephone use, supported by clear visual and auditory ability. Cognitive and emotional demands are high due to extended concentration, frequent interruptions, independent decision-making, and information processing. Although physical exposure is low, administrative areas within healthcare environments may occasionally involve contact with infectious agents. Some roles may require flexible hours, TB screening, or a valid driver's license. For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements. Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations.

PAY RANGE: $75,700.00 - $101,000.00

CITY: Rochester

POSTAL CODE: 14607

The posted pay range is a good faith representation of potential base pay for this position. It may be modified in the future and eligible for additional pay components.

Individual annual salaries/hourly rates could vary based on position details and FTE. Pay is determined by considering factors including, but not limited to, experience, relevant qualifications, specialty, internal equity, locations, and contracts.

Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.

Rochester Regional Health is an integrated health services organization serving the people of Western New York, the Finger Lakes, St. Lawrence County, and beyond. The system includes nine hospitals; primary and specialty practices, rehabilitation centers, ambulatory campuses and immediate care facilities; innovative senior services, facilities and independent housing; a wide range of behavioral health services; and Rochester Regional Health Laboratories and ACM Global Laboratories, a global leader in patient and clinical trials.

Its vision is to lead the evolution of healthcare to enable every member of the communities it serves to enjoy a better, healthier life.