The Director is primarily responsible for managing utilization review and discharge planning activities, as well as addressing psychosocial needs to appropriately transition patients through the continuum of care. Working collaboratively with the MD Advisor for Care Management, the Director also is responsible for building coalitions with all members of the care team as well as hospital and health system leadership to implement changes to improve patient flow, the patient experience, and staff and physician satisfaction, as well as increase reimbursement and reduce denials.
RESPONSIBILITIES:
Lead the development, implementation, and evaluation of strategic department plans to optimize length of stay, discharge planning, patient flow, and resource utilization across the hospital.
Oversee utilization and denial management programs, ensuring appropriate levels of care, strong payer relationships, adherence to regulations, and proactive strategies to reduce denials and prevent readmissions.
Build and maintain effective internal and external partnerships to drive process improvement, monitor performance metrics, and support optimal clinical, operational, financial, and patient satisfaction outcomes.
Manage departmental operations including staffing, budgeting, role development, performance evaluations, regulatory compliance, and quality review processes.
Serve as a consultant and liaison for long-term care facilities and state agencies, ensuring regulatory alignment, supporting complex psychosocial needs, and guiding policy, risk management, and patient experience initiatives.
Perform other related duties as assigned.
REQUIRED QUALIFICATIONS:
BSN or Master's Degree in Social Work
RN or LMSW license
Minimum of five years in Health Care setting, three years in supervisory capacity
PREFERRED QUALIFICATIONS:
Case management/utilization review/discharge planning experience
EDUCATION:
MS: Social Work (Required)
LICENSES / CERTIFICATIONS:
BLS - Basic Life Support - American Heart Association (AHA)American Heart Association (AHA)American Heart Association (AHA), LCSW - Licensed Clinical Social Worker - New York State Education Department (NYSED)New York State Education Department (NYSED)New York State Education Department (NYSED)
PHYSICAL REQUIREMENTS:
S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
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:
$85,000.00 - $135,000.00
CITY:
Rochester
POSTAL CODE:
14617
The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, 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, headquartered in Rochester, NY, is an integrated health services organization serving the people of Western New York, the Finger Lakes, St. Lawrence County, and beyond. We are dedicated to helping our community stay healthy and live fulfilling lives. Together, we find the best way forward to where you want to be. From western to northern New York, rest assured; we’ve got you covered. We see you. We’re with you. We’re here to uplift you—to treat people, not symptoms. To treat you well.
Our experience is nation-leading, neighbor-driven, and rooted in generations of real-life care. Today, we offer comprehensive care from 500+ locations, including 8 hospitals; more than 300 primary and specialty practices, rehabilitation centers and ambulatory campuses; innovative senior services, facilities and independent housing; a wide range of behavioral health services; and ACM Global Laboratories, a global leader in patient and clinical trials.
Whatever you need, from every age, to every stage, across every service line, and every symptom... Whatever it is, we’re here for it.
Learn more about Rochester Regional Health at careers.rochesterregional.org.
Rochester Regional Health is an Equal Opportunity/Affirmative Action Employer. Minority/Female/Disability/Veteran
