Employer: University of Illinois – Chicago
Hiring Department: Continuum of Care
Job Title: Health Care Utilization Review Coordinator
Additional Information: https://uic.csod.com/ux/ats/careersite/1/home/requisition/8400?c=uic
Description:
Position Summary
Health Care Utilization Review Coordinator (HURC) is accountable for coordinating and facilitating patient services across the various levels of the continuum utilizing Relationship-Based Care model as the framework. The HURC takes initiative to improve patient outcomes by integrating Shared Leadership, Evidence Based Practice and Magnet's Five Models of Care into clinical practice. Through therapeutic relationships with patients, families, self and colleagues, the HURC functions as an interdisciplinary team member who assist patients and their families in navigating through the healthcare system based on individual and patient population needs. In addition to the care facilitation, the HURC will perform related duties including utilization management, discharge planning and referral to other levels of care and fulfills unit and organizational goals
Duties & Responsibilities
Facilitates coordination of patient services in assigned patient care unit, or department
Collaborates with the patient, family, physicians, RNs, and multidisciplinary team to assure_x000d_ appropriate safe, cost effective, timely and efficient services
Identifies variations in the utilization of benefits with payors to fund the continuing or alternative care_x000d_ plan, where possible_x000d_
Provides utilization management functions for patients: pre-certification (primarily a function of the_x000d_ Admissions Department), continued stay reviews and retro-reviews. Assist physicians with determining_x000d_ CLOC and medical necessity. Facilitates appropriate clinical level of care determination and_x000d_ conversion, if necessary. Responsible for notification to the Admissions Department of CLOC_x000d_ conversions. Monitors internal and external UR guidelines for patients in assigned units or department. Communicates key UM information to units and attending physicians or their _x000d_ representative and managed care companies _x000d_
Applies approved utilization acuity criteria to monitor appropriateness of CLOC and continued stays_x000d_ and documents finding based on department standards
Inputs and maintains utilization management data into computer system
Participates in gathering and reporting data, such as variances, LOS, cost and outcomes
Qualifications:
Minimum Qualifications
- Graduation from an accredited professional nursing program
- Current licensure as a Registered Professional Nurse with the Illinois Department of Financial and Professional Regulation, Division of Professional Regulation.
- Five years (60 months) of RN experience.
- Current AHA BLS/CPR and other required unit specific certifications
- Effective communication skills (oral and written) that facilitate therapeutic relationships between patients, family, and health care providers
- Intermediate computer skills with the ability to become proficient in the Electronic Health Record (EHR) with on-the-job training
- Excellent attendance, interpersonal skills and work history required.
- Candidate must have 3-5 years experience in Behavior Health
Preferred Qualifications
BSN preferred
ACMA or CCM certified
Behavior Health Utilization Review expericence
