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T.H. Utilization Review and Quality Assurance Coordinator (SL3)

This title is in the unclassified service and in the SUNY Professional Services Negotiating Unit.

In many hospitals the Quality Assurance and Utilization Review function are combined administrators state that this makes for increased efficiency versus a split function whereby two separate individuals examine each record. Incumbents in these positions ensure that patient care services are appropriately recorded and utilized in accordance with hospital standards of quality and the policies of regulatory agencies. Review of the position with hospital administrators indicates possible changes will be mandated by regulatory agencies that could result in functional changes.

• Conducts reviews of pre-admission certification forms;
• conducts admission and continued stay reviews of all patients admitted to the hospital within one working day of admission and every three to dour days during continued hospital stay;
• assigns lengths of stay and determines levels of care other than acute by diagnosis following HCFA, IPRO and University Hospital criteria;
• reviews all patients' Utilization Review data forms on admission to determine discharge planning needs;
• refers to the Social Work Department all high risk patients or any patient requiring discharge planning assistance;
• reviews all cases which are hospitalized twenty days or more and refers them to Social Work Department is discharge planning assistance is needed;
• follows up on all cases referred to Social Work Department to assure timely University Hospital intervention and documentation of discharge planning;
• initiates and updates forms cyclically for patients awaiting Long Term Case Coordinator in the Social Work Department;
• contacts appropriate home care agency to arrange for Visiting Nurse, equipment, etc. for patients waiting for discharge planning assistance that is lesser than skill level;
• conducts retrospective reviews of all patients discharged from University Hospital;
• maintains availability in assigned areas for contacting attending physicians, house staff and other hospital personnel to ensure ongoing documentation of the care being provided, the treatment plan and discharge plan, or the correction for any other deficiencies identified.

Preferred Qualifications:

RN required with two years clinical experience.

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