UI Health - Healthcare Utilization Review Coordinator II

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

Advocates for patients, families, and their significant others, the community, and the nursing profession.

Facilitates coordination of patient services in assigned patient care unit, or department by collaborating with the patient, family, physicians, RNs, and multidisciplinary team to assure appropriate safe, cost effective, timely and efficient services.

Communicates and coordinates with all staff in developing and implementing the discharge planning process including appropriate Clinical Level of Care, continued stay, patient assessment, planning, implementation, interdisciplinary collaboration, and ongoing evaluation.

Identifies variations in the utilization of benefits with payors to fund the continuing or alternative care plan, where possible

Documents and reviews risk assessment and discharge planning information in the medical record according to department standards including applying approved utilization acuity criteria and verifying that admitting or referral source has pre-certified and considers budgetary aspects of care.

Assists in identifying system problems and issues that impede (impeding) diagnostic or treatment progression to the appropriate administrative liaison. Collaborates with the interdisciplinary team when delays occur in consults, treatments, discharge planning, or procedures to facilitate timely, cost-effective delivery of patient services.

Facilitates daily communication (e.g. patient rounds, multidisciplinary team meetings and conferences) with the interdisciplinary team to discuss plan of care and assist with expediting care across the continuum

Maintains expertise through participation in continuing education programs. Serves as experienced resource and patient services facilitation reference for care team members.

Receives and provides feedback to members of the health care team regarding performance/practice.

Collaborates with other nurses and physicians to identify, promote and provide positive learning experiences for staff and students.

Other Duties as Assigned.

Perform other related duties and participate in special projects as assigned.