What are the responsibilities and job description for the Health Care Utilization Review Coordinator position at UI Health?
Hiring Department: Health Care Utilization Review Coordinator
Location: Chicago, IL USA
Requisition ID: 1028904
FTE: 1
Work Schedule: 8 to 4:30
Shift: Days
# of Positions: 1
Posting Close Date
Salary: The previously determined range for this position was $35.72- $71.67. The final rate offered will be determined by the collective bargaining agreement, internal salary equity, candidate experience and qualifications, and budget constraints. It is not typical for an individual to be offered a rate at or near the top of the full range for a position.
This position requires Illinois residency within 180 days of the hire date.
About the University of Illinois Hospital & Health Sciences System (UI Health)
The University of Illinois Hospital & Health Sciences System (UI Health) provides comprehensive care, education, and research to the people of Illinois and beyond. A part of the University of Illinois Chicago (UIC), UI Health comprises a clinical enterprise that includes a Joint Commission-accredited tertiary care hospital and outpatient clinics, and the Mile Square Health Center network of federally qualified health centers. It also includes the seven UIC health science colleges: the College of Applied Health Sciences; the College of Dentistry; the School of Public Health; the Jane Addams College of Social Work; and the Colleges of Medicine, Pharmacy, and Nursing, including regional campuses in Peoria, Quad Cities, Rockford, Springfield, and Urbana. UI Health is dedicated to the pursuit of health equity. Learn more: https://hospital.uillinois.edu/about-ui-health
The University of Illinois Chicago offers a very competitive benefits portfolio. Click for a complete list of Employee Benefits .
Position Summary
The HURC II is accountable for coordinating and facilitating patient services across the various levels of contium utilizating relationship-base care model as the framework. The HURC II takes initiative to improve patient outcomes by integrating Shared Leadership, Evidence Based practice and Magnets Five Models of Care into clinical practice. Through therapeutic relationships with patients families, self and their families in navagating through health care system based on individual patient population needs. In addition to the care facilatation, the HURC II will perform related duties including Utilization management aspects of securing and validating payor authorizations for clinical services which support the care continum and fulfills unit and organizational goals.
Duties & Responsibilities
Provides utilization management functions for patients: pre-certification (primarily a function of the Admissions Department), Continued stay reviews and retro-reviews.
Applies approved utilization acuity criteria to monitor appropriateness of CLOC and continued stays and documents finding based on department standards.
Assist physicians with determining CLOC and medical necessity. Facilitates appropriate clinical level of care determination and conversions if necessary.
Responsible for notification to the Admissions Department of CLOC conversions.
Monitors internal and external UR guidelines for patients in assigned units or departments. Com-municates key UM information to units and attending physician or their representative and man-aged care companies.
Inputs and maintains utilization management data into computer system.
Perform other related duties and participate in special projects as assigned.
Minimum Qualifications
Please note that once you have submitted your application you will not be able to make any changes. In order to revise your application you must withdraw and reapply. You will not be able to reapply after the posting close date. Please ensure the application is fully completed and all supporting documents have been uploaded before the posting close date.
The University of Illinois System is an equal opportunity employer, including but not limited to disability and/or veteran status, and complies with all applicable state and federal employment mandates. Please visit Required Employment Notices and Posters to view our non-discrimination statement and find additional information about required background checks, sexual harassment/misconduct disclosures, and employment eligibility review through E-Verify.
The university provides accommodations to applicants and employees. Request an Accommodation
Location: Chicago, IL USA
Requisition ID: 1028904
FTE: 1
Work Schedule: 8 to 4:30
Shift: Days
# of Positions: 1
Posting Close Date
Salary: The previously determined range for this position was $35.72- $71.67. The final rate offered will be determined by the collective bargaining agreement, internal salary equity, candidate experience and qualifications, and budget constraints. It is not typical for an individual to be offered a rate at or near the top of the full range for a position.
This position requires Illinois residency within 180 days of the hire date.
About the University of Illinois Hospital & Health Sciences System (UI Health)
The University of Illinois Hospital & Health Sciences System (UI Health) provides comprehensive care, education, and research to the people of Illinois and beyond. A part of the University of Illinois Chicago (UIC), UI Health comprises a clinical enterprise that includes a Joint Commission-accredited tertiary care hospital and outpatient clinics, and the Mile Square Health Center network of federally qualified health centers. It also includes the seven UIC health science colleges: the College of Applied Health Sciences; the College of Dentistry; the School of Public Health; the Jane Addams College of Social Work; and the Colleges of Medicine, Pharmacy, and Nursing, including regional campuses in Peoria, Quad Cities, Rockford, Springfield, and Urbana. UI Health is dedicated to the pursuit of health equity. Learn more: https://hospital.uillinois.edu/about-ui-health
The University of Illinois Chicago offers a very competitive benefits portfolio. Click for a complete list of Employee Benefits .
Position Summary
The HURC II is accountable for coordinating and facilitating patient services across the various levels of contium utilizating relationship-base care model as the framework. The HURC II takes initiative to improve patient outcomes by integrating Shared Leadership, Evidence Based practice and Magnets Five Models of Care into clinical practice. Through therapeutic relationships with patients families, self and their families in navagating through health care system based on individual patient population needs. In addition to the care facilatation, the HURC II will perform related duties including Utilization management aspects of securing and validating payor authorizations for clinical services which support the care continum and fulfills unit and organizational goals.
Duties & Responsibilities
Provides utilization management functions for patients: pre-certification (primarily a function of the Admissions Department), Continued stay reviews and retro-reviews.
Applies approved utilization acuity criteria to monitor appropriateness of CLOC and continued stays and documents finding based on department standards.
Assist physicians with determining CLOC and medical necessity. Facilitates appropriate clinical level of care determination and conversions if necessary.
Responsible for notification to the Admissions Department of CLOC conversions.
Monitors internal and external UR guidelines for patients in assigned units or departments. Com-municates key UM information to units and attending physician or their representative and man-aged care companies.
Inputs and maintains utilization management data into computer system.
Perform other related duties and participate in special projects as assigned.
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.
- 2 to 4 years of utilization review & utilization management 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.
- MSN
- CCM or ACMA certification
Please note that once you have submitted your application you will not be able to make any changes. In order to revise your application you must withdraw and reapply. You will not be able to reapply after the posting close date. Please ensure the application is fully completed and all supporting documents have been uploaded before the posting close date.
The University of Illinois System is an equal opportunity employer, including but not limited to disability and/or veteran status, and complies with all applicable state and federal employment mandates. Please visit Required Employment Notices and Posters to view our non-discrimination statement and find additional information about required background checks, sexual harassment/misconduct disclosures, and employment eligibility review through E-Verify.
The university provides accommodations to applicants and employees. Request an Accommodation
Salary : $36 - $72
