Utilization Review Coordinator
Penn Medicine Home Health
2015 Administration/Shared Services
Quality Compliance and Education
Utilization Review Coordinator serves as a role model and educator for quality care by demonstrating knowledge in regulatory and compliance affairs.
ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:
- Maintains accurate, timely data entry in utilization management tools (OASIS) using the established guidelines and in support of an efficient and effective revenue cycle.
- Reviews and ensures appropriate and timely documentation of plan of care, recommending corrections as appropriate.
- Audits clinical records for appropriate utilization of services, quality outcome measurement, standards of practice and to ensure regulatory compliance. Identifies and provides corrective action or referrals on any quality, risk, or documentation issues that are found.
- Reviews admission charts, visit notes, recertification and discharge documentation to identify learning needs of staff to ensure compliance with agency and regulatory standards.
- Assists in developing educational programs that will improve individual and group performance.
- Serves as a resource to employees related to appropriate documentation.
SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above:
- Actively participates in orientation and ongoing educational programs Assists in the preceptor program development and implementation and provides ongoing evaluation on effectiveness, and revisions as indicated by staff needs
- Participates in general functions of the Quality Department.
- Other duties as assigned.
MINIMUM REQUIRED QUALIFICATIONS:
- High school diploma or equivalent.
- Current licensure as a Registered Professional Nurse (RN) issued by the PA State Board of Nursing.
- Two (2) years home health nursing experience.
- Ability to teach and role model for colleagues.
- Experience in quality management and utilization review preferred
- OASIS experience and certification preferred
Attention/Concentration: The following level of ability is essential for the jobholder to focus on certain aspects of current experience and reject others.
- The position requires the ability to attend to more than one aspect of a situation simultaneously. It is highly likely that multiple task demands are going to be required of the individual at the same time.
New Learning and Memory: The following level of ability is essential for the jobholder to learn and retain material.
- The position requires that an individual be able to learn new tasks quickly and effectively. Job requirements change frequently. The ability to understand and carry out detailed, involved instructions is mandatory. A portion of this position requires reliance on verbal memory and new learning. Efficiency in processing, organizing and categorizing of spoken or written information so that later recall is feasible is a major requirement and prerequisite of the job.
Problem Solving, Reasoning and Creative Thinking: The following level of ability that is essential for the jobholder to think (in order to solve a problem) by combining two or more elements from past experience or imaginative thought.
- The position deals with issues or problems that often require thoughtful reasoning before arriving at approaches or solutions. Some independent thought, planning or origination of options and solutions is necessary. The individual must have the ability to apply principles of reasoning and problem solving to resolve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
APTITUDES: The following are essential requirements of the position in relation to job-worker situations. These items describe how a worker must adapt, adjust, conform or act.
Leadership, control and planning: Ability to accept responsibility for leadership, direction, control, planning, negotiating, organizing, directing, supervising, formulating practices, or making final decisions.
Performing under stressful conditions: Ability to perform under stress when confronted with emergency, critical, unusual, or dangerous situations, or in situations in which working speed and sustained attention are critical aspects of the job. Is subject to danger or risk, or to tension as a regular, consistent part of the job.
Variety and change: Ability to perform a variety of duties, often changing from one task to another of a different nature without loss of efficiency or composure involving significant differences in technologies, techniques, procedures, environmental factors, physical demands, or work situations.
Communication: Ability to exchange information with others clearly and concisely; to present ideas, facts and technical information.
Interpersonal relations: Ability to maintain relationships that facilitate task accomplishment; to cooperate and resolve conflicts; to recognize needs and be sensitive of others.
EQUIPMENT USAGE REQUIREMENTS
Equipment/Tools: Computer, Phone, Copier, Printer, Fax, Office Supplies, medical records
Software: Microsoft Office Products, clinical information system, utilization tracking system
Rarely 0-10%; Occasionally 11-35%; Frequently 36-70%; Continuously 71-100%
- Sit: Frequently
- Stand: Frequently
- Walk: Frequently
- Bend: Rarely
- Push: Rarely
- Pull: Rarely
- Kneel/Squat: Rarely
- Reach: Rarely
- Twist: Rarely
- Balance: Rarely
- Climb: Rarely
Lifting: Degree of physical exertion is: Light, exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to move objects.
Sensory Abilities specifically required:
WORKING CONDITIONS: Exposure to hazardous conditions/ materials is negligible.
Disclaimer: This job description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be a reflection of those principal job elements essential for recruitment and selection, for making fair job evaluations, and for establishing performance standards. The percentages of time spent performing job duties are estimates, and should not be considered absolute. The incumbent shall perform all other functions and/or be cross-trained as shall be determined at the sole discretion of management, who has the right to amend, modify, or terminate this job in part or in whole. Incumbent must be able to perform all job functions safely.
Posted on 01/31/2020