RN Duties

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

Facilitates coordination of patient services in assigned patient care unit, or department
?Collaborates with the patient, family, physicians, RNs, and multidisciplinary team to assureappropriate safe, cost effective, timely and efficient services. Utilizes clinical and social work expertsas needed to ensure delivery of comprehensive patient services
?Collaborates and communicates with all staff in developing and implementing the discharge planningprocess including: appropriate CLOC, continued stay, patient assessment (for appropriate ClinicalLevel of Care (CLOC), continued stay, planning, implementation, interdisciplinary collaboration andongoing evaluation
?Identifies variations in the utilization of benefits with payors to fund the continuing or alternative careplan, where possible
?Documents risk assessment and discharge planning information in the medical record according todepartment standards
?Coordinates and provides discharge planning. Screens patients for high risk discharge planning needsand assures collaboration with interdisciplinary team members
?Provides utilization management functions for patients: pre-certification (primarily a function of theAdmissions Department), continued stay reviews and retro-reviews. Assist physicians with determiningCLOC and medical necessity. Facilitates appropriate clinical level of care determination andconversion, if necessary. Responsible for notification to the Admissions Department of CLOCconversions. 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 staysand documents finding based on department standards
?Inputs and maintains utilization management data into computer system.
?Verifies that admitting or referral source has pre-certified the patient admission and scheduledprocedures
?Assists in identifying system problems and issues that impede (impeding) diagnostic or treatmentprogression to the appropriate administrative liaison. Collaborates with the interdisciplinary teamwhen 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 andconferences) with the interdisciplinary team to discuss plan of care and assist with expediting careacross the continuum
?Participates in gathering and reporting data, such as variances, LOS, cost and outcomes
?Reviews and provides input into policies and procedures related to continuum of care and patientservices facilitation
?Maintains expertise through participation in continuing education programs. Serves as experiencedresource and patient services facilitation reference for care team members
?Assesses discharge environment and family systems
?Participates in internally and externally driven quality improvement programs

Advocates for patients, families, and their significant others, the community, and the nursingprofession
?Integrates theoretical knowledge, evidence-based research, current standards of practice and clinicalexperience to provide “quality” patient care as measured by established nursing quality standards andother governing/accrediting health care bodies.
?Recognizes and supports Shared Leadership as the selected method of nursing governance
?Participates in organizational, departmental and shared leadership activities; supports departmentand unit goals in daily behavior.
?Demonstrates accountability for job performance by: (1) seeking opportunities to enhance job skillsand knowledge; (2) maintaining conditions of employment (RN licensure, BLS and other required unit-specific certifications).
?Receives and provides feedback to members of the health care team regarding performance/practice.

RN License required.

Current AHA BLS/CPR and other required unit-specific certifications

Five years (60 months) of medical surgical experience required

Basic computer skills with the ability to become proficient in Epic

Knowledge and/or experience of utilization review procedures and techniques (e.g. InterQual, Milliman), third party reimbursement guidelines, Managed Care, Federal, and State regulatory guidelines

Excellent attendance, interpersonal skills and work history required.