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

Provides utilization management functions for patients: pre-certification (primarily a function of the_x000D_Admissions Department), continued stay reviews and retro-reviews. Assist physicians with determining_x000D_CLOC and medical necessity. Facilitates appropriate clinical level of care determination and_x000D_conversion, if necessary. Responsible for notification to the Admissions Department of CLOC_x000D_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_x000D_and documents finding based on department standards

Inputs and maintains utilization management data into computer system._x000D_

Participates in gathering and reporting data, such as variances, LOS, cost and outcomes.

Participates in internally and externally driven quality improvement programs._x000D_