Utilization Review Coordinator

Patient Care Coordinator

Lexington Regional Health Center

Principle duties and responsibilities:

1. Coordinates the care and discharge planning of hospitalized patients from a multi-disciplinary stand point.

2. Coordinates multi-disciplinary rounding to include: provider rounds, daily huddle, weekly discharge planning meeting, etc.

3. May assist or conduct patient discharges by providing health education management to patients and their support systems, regarding post hospital care and may coordinate needed resources when applicable.

4. Works to provide safe transitions from the hospital to home while ensuring patient safety, patient understanding of their care plan and future plans, along with reducing readmissions.

5. Works collaboratively with all aspects of patient care team to include various healthcare professionals, hospital departments, community resources and the patient.

6. Coordinates and collects quality data including call backs, population health data, swing-bed and Utilization Review.

7. Assists with goals to reduce readmissions, over utilization of Emergency Room. Through chart reviews, process improvements and etc. Such as contacting patients after dismissal to ensure that the plan of care was understood and followed. (Medication reconciliation, future appointments are made and any patient questions are answered.)

8. Attends a participates in Hospital Acquired Condition meeting and Utilization Review Committee.

9. Help assist patients and designated support system on preventive measures, disease management, health care management throughout the health system, etc.

10. Manages and intakes swing bed referrals. Communicates with multidisciplinary team to ensure patient centered holistic care and develop a multidisciplinary plan of care through IDT meetings. Ensure documenting of certification of stay and recertification's. Complies with all swing-bed rules and regulations. May assist with swing-bed chart reviews,

11. Maintains medical record documentation to accurately reflect care administered and patient's condition. Records all care information concisely, accurately and completely in a timely manner in the appropriate format and on the appropriate forms.

12. Provides holistic support to patients and patient designated support system.

13. Coordinate care and follow through with plan of care to patients enrolled in chronic care management.

14. Consults with Remote Utilization Review for precertification's, assures medical criteria is met for admission to appropriate service by discussion with providers and reviewing documentation.

15. Assist in Chart Review Audits for Utilizations Review Committee.

16. Rotating for UR call to ensure appropriate UR coverage on weekends.

17. Participates in patient care activities that could include blood exposure and risk to bloodborne pathogens (eg: lacerations, handling of blood-contaminated specimens, etc.)

18. Responsible for safe bagging and disposal of biohazardous waste.

19. Responsible for following safe-injection practices.

20. Responsible for ensuring the environment meets appropriate governing body standards.

21. Ensure patients and visitors follow current infection control guidelines.

22. Responsible for proper collection, storage and labeling of biological specimens.

23. Maintains patient and staff safety through the use of patient safety tools (TeamSTEPPS, Just Culture, etc.).

24. Communicates all departmental concerns with the Director of Transitional Care and/or Chief Nursing Officer.

25. Regular attendance at the assigned work location is required.

26. Performs all other duties as assigned.

Minimum knowledge, skills, and abilities:

1. Requires knowledge and understanding of nursing theory and practice and the growth and development of a variety of patients in order to meet the patients' health care needs as is typically acquired through the completion of an Associate's or Bachelor's degree in Nursing from an accredited school. Bachelor's degree preferred.

2. Must hold a current active Nurse license from the State of Nebraska or approved compact state of residence as defined by the Nebraska Nurse Practice Act.

3. Two years nursing experience required.

4. BLS required within six months of hire and/or orientation.

5. Ability to maintain strict confidentiality with regard to protected and sensitive information.

6. Ability to complete reports and correspondence at a professional level.

7. Ability to immediately respond to common inquires and complaints from patients, employees, and regulatory agencies.

8. Advanced communication skills to respond to inquiries from Insurance companies and Workman Compensation companies

9. Ability to effectively communicate with individuals from diverse backgrounds.

10. Successful completion of required knowledge and training of standard precaution and transmission protocols and when to apply during principle duties and responsibilities.

Working conditions:

1. Workers in the office spend up to 75% of shift sitting to complete desk work and 25% of shift helping manage nursing or assisting with patient care. Will be required to reach shelves of varying heights in offices up to 60 inches high with minimal weighted objects. Office personnel may be required to assist with patient care in the various sections of nursing. If patient care is part of an office worker's job, they will need to be able to perform the physical demands of that area per its job description. Please see appropriate job description for specific demands.

2. Acute Care Nurse: May spend up to 75% of shift completing patient care activities, requiring ambulating and an appropriate body position to complete a task such as squatting or kneeling to help assist patient with dressing. Rest of shift may be spent completing paperwork or computer work for documentation. Transferring patients occasionally to frequently, depending on case load, requires lift of 35 pounds to assist in transfers. A hoyer lift, sit-to-stand lift, or extra assistance may be needed on patients that require extra assist in transfers above the 35 pounds. Nursing COW, which is occasionally utilized for documentation and delivering medication, requires 15 horizontal force pounds to maneuver cart 200 feet at one time. 17 pound commodes are carried to patient specific rooms up to 200 feet. Transporting patient recliners from room to room up to 150 feet is completed. Wheelchairs require up to 40 horizontal force pounds to transport patients up to 300 feet. Hospital beds require 60 horizontal force pounds to move bed 2 feet or to initiate movement and require 40 horizontal force pounds up to 200 feet to transport patient from room to room, many times completed by 2 person assist. Acute care shelves are to be stocked, reaching 17 inches from floor up to 83 inches high, which may require use of a step stool to reach appropriate heights. IV bags weighing 7 pounds are lifted up to variable heights overhead to be attached to IV poles. Crash cart requires 20 horizontal force pounds to transport up to 150 feet in emergency situations. Chest tube tray in ER weighing 8 pounds is used in appropriate situations, transported up to 200 feet from ER to patient room. Auto CPR device weighs 25 pounds and is used in emergency situations to be transported up to 200 feet from ER to patient room. In emergency situations, nurse may be required to get onto floor to perform CPR or other emergent patient care. Crawling or getting onto floor may be required to clean up messes made in patient rooms as well.

3. Exposure to chemicals and other hazards related to patient care. Appropriate safety precautions, such as safety glasses, gloves, etc. must be used to minimize risk of injury. 4. Direct exposure to body substances during patient care activities and on contaminated surfaces such as patient equipment.

Management responsibilities:

1. None.

Job description statements are intended to describe the general nature and level of work being performed by employees assigned to this job title. They are not intended to be a complete list of all responsibilities, duties and skills required.