at University of Illinois at Chicago in Chicago, Illinois, United States
Job Description
Health Care Utilization Review Coordinator (Float)
Health Care Utilization Review Coordinator (Float)
Hiring Department: Health Care Utilization Review Coordinator (Float)
Location: Chicago, IL USA
Requisition ID: 1026672
Posting Close Date: 08/23/2024
About the University of Illinois Chicago
FTE: 1.0
Shift: Days
Schedule: Tues-Sat, 8-4:30
UIC is among the nation's preeminent urban public research universities, a Carnegie RU/VH research institution, and the largest university in Chicago. UIC serves over 34,000 students, comprising one of the most diverse student bodies in the nation and is designated as a Minority Serving Institution (MSI), an Asian American and Native American Pacific Islander Serving Institution (AANAPSI) and a Hispanic Serving Institution (HSI). Through its 16 colleges, UIC produces nationally and internationally recognized multidisciplinary academic programs in concert with civic, corporate and community partners worldwide, including a full complement of health sciences colleges. By emphasizing cutting-edge and transformational research along with a commitment to the success of all students, UIC embodies the dynamic, vibrant and engaged urban university. Recent "Best Colleges" rankings published by U.S. News & World Report, found UIC climbed up in its rankings among top public schools in the nation and among all national universities. UIC has over 300,000 alumni, and is one of the largest employers in the city of Chicago.
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
Identifies variations in the utilization of benefits with payors to fund the continuing or alternative careplan, where possible
Provides utilization management functions for patients: pre-certification (primarily a function of the Admissions Department), continued stay reviews and retro-reviews. Assist physicians with determining CLOC and medical necessity. Facilitates appropriate clinical level of care determination and conversion, if necessary. Responsible for notification to the Admissions Department of 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 representative and managed care companies.
Applies approved utilization acuity criteria to monitor appropriateness of CLOC and continued stays 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
Perform other related duties and participate in special projects as assigned.
Qualifications:
Minimum Qualifications
1. Graduation from an accredited professional nursing program
2. Current licensure as a Registered Professional Nurse with the Illinois Department of Financial and Professional Regulation, Division of Professional Regulation.
3. Five years (60 months) of RN experience.
4. 2 to 4 years of utilization review & utilization management experience.
5. Current AHA BLS/CPR and other required unit specific certifications
6. Effective communication skills (oral and written) that facilitate therapeutic relationships between patients, family, and health care providers
7. Intermediate computer skills with the ability to become proficient in the Electronic Health Record (EHR) with on-the-job training
8. Excellent attendance, interpersonal skills and work history required.
Preferred... For full info follow application link.
The University of Illinois may conduct background checks on all job candidates upon acceptance of a contingent offer. Background checks will be performed in compliance with the Fair Credit Reporting Act.
The University of Illinois Chicago is an affirmative action, equal opportunity
institution/employer and does not discriminate on the basis of race, color, national origin, sex, religion, age, sexual orientation, gender identity, veteran or disability status, height, weight, or marital status in employment or the provision of services.
