Clinical

 Facilitates coordination of patient services in assigned patient care unit, or department ? Collaborates with the patient, family, physicians, RNs, and multidisciplinary team to assure appropriate safe, cost effective, timely and efficient services. Utilizes clinical and social work experts as needed to ensure delivery of comprehensive patient services ? Collaborates and communicates with all staff in developing and implementing the discharge planning process including: appropriate CLOC, continued stay, patient assessment (for appropriate Clinical Level of Care (CLOC), continued stay, 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 risk assessment and discharge planning information in the medical record according to department standards ? Coordinates and provides discharge planning. Screens patients for high risk discharge planning needs and assures collaboration with interdisciplinary team members ? 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 CLOC conversions. Monitors internal and external UR guidelines for patients in assigned units or Job Description Disclaimer This job description reflects the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job. Nothing restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Page 2 of 4 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. ? Verifies that admitting or referral source has pre-certified the patient admission and scheduled procedures ? 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, costeffective 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 ? 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 patient services facilitation ? Maintains expertise through participation in continuing education programs. Serves as experienced resource and patient services facilitation reference for care team members ? Assesses discharge environment and family systems ? Participates in internally and externally driven quality improvement programs

Professional/Leadership

? Advocates for patients, families, and their significant others, the community, and the nursing profession ? Integrates theoretical knowledge, evidence-based research, current standards of practice and clinical experience to provide “quality” patient care as measured by established nursing quality standards and other 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 department and unit goals in daily behavior. ? Demonstrates accountability for job performance by: (1) seeking opportunities to enhance job skills and knowledge; (2) maintaining conditions of employment (RN licensure, BLS and other required unitspecific certifications). ? Receives and provides feedback to members of the health care team regarding performance/practice.

Organizational

 Adheres to the UI Health Code of Conduct. ? Treats patients/families, staff, students and visitors with respect and dignity. ? Adheres to Nursing’s time, overtime and attendance policies. ? Completes electronic learning modules and related programs as assigned by Organizational Development by established date ? Complies with University Health Services TB and fit-testing requirements ? Utilizes established communication channels/chain of command to escalate or resolve patient care problems. ? Identifies recurring clinical practice and/or related unit problems and participates in problem solving and resolution. Job Description This job description reflects the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job. Nothing restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Education/Research

 Collaborates with other nurses and physicians to identify, promote and provide positive learning experiences for staff and students ? Serves as preceptor, mentor, and resource to other nursing staff and students. ? Supports nursing and multidisciplinary research efforts conducted on the unit and in the Hospital & Clinics ? Accesses Hospital intranet for relevant communication and to review and interpret changes in policy, procedure and other information pertinent to practice ? Takes responsibility for continued professional growth/development by identification of learning needs and initiates strategies to meet such needs.

Reporting Structure

This person works independently within the scope of nursing practice. The Assistant Director of  Utilization Management, acting as coach and mentor, provides direction, guidance, and feedback regarding practice and performance. The employee’s performance is evaluated annually in writing and more frequently if needed. The employee and Director/Manager meet on an as needed basis for coaching and mentoring where support, guidance and direction can be given. The RN provides and receives input from peers regarding practice/performance 

Current license as a Professional Registered Nurse from the State of Illinois Current AHA BLS/CPR and other required unit-specific certifications Five years (60 months) of medical/surgical experience. Basic computer skills with the ability to become proficient in Epic Knowledge and/or preferred experience of utilization review procedures and techniques (e.g. InterQual,), third party reimbursement guidelines, Managed Care, Federal, and State regulatory guidelines 

Excellent attendance, interpersonal skills and work history required.