Utilization Review Educator

Reports to the Manager/Utilization Review and Case Management. Is responsible for assessing, planning, coordinating and evaluating orientation, continuing education and in-service programs for staff which are competency based. Recommends improvements in the quality of utilization review practice and standards. Serves as a resource to staff. Assists with steps to resolve preventable denials and coordinates with the Manager to identify and correct weaknesses in the revenue cycle process that can mitigate future denials.

• MISSION:
  We deliver outstanding care, inspire health, and connect with heart.
• VALUES:
  Trust. Respect. Integrity. Compassion.
• SERVICE GOALS:
  Personally connect. Keep everyone informed. Be on their team.

• Develops curriculum and keeps current new hire orientation for all positions affecting UR at both hospitals and any other positions associated with UR Departments.
• Develops schedules, teaching methods, evaluation tools, preceptor development programs, and coordinates for all parties a smooth onboarding and training process.
• Works with manager to assure performance progress is documented and feedback whether positive or corrective for timely movement through orientation phase.

• Assess learning needs of UR associates and develops plan, goals, and validates with management and associates.
• Assures competency assessment of staff working in UR Process through audits, direct observations/discussions, and individual education plans as needed.
• Responsible for all staff development activities around upgrades to UR tools, criteria sets, and other mechanisms/processes needed in UR process.
• Assists as a resource regarding UR situations of concern and decision making.
• Keeps records of all education and competency validation activities.

• Leads or participates in strategic initiatives in the revenue cycle where utilization review plays a role and communicates relevant information to other departments
• Supports management communications and actions to assure effective change management culture in departments.

• Evaluates work processes, identifies inefficiencies, lack of standardization, and opportunities for improvement.
• Collects information through data collection, observations, surveys, interviews, etc., to analyze the process.
• Develops metrics for success and collaborative approach to design improvement.
• Implements PDCA and LEAN tools as indicated to refine, measure, revise, and sustain improved processes in UR.
• Monitors select measures for oversight committees and prepares timely reports.

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established time frames.
• Completes annual employee health requirements within established time frames.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

• Leverage innovation everywhere.
• Cultivate human talent.
• Embrace performance improvement.
• Build greatness through accountability.
• Use information to improve and advance.
• Communicate clearly and continuously.

• The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a Bachelor of Science in Nursing degree and current license to practice as a Registered Nurse in Indiana. A Master's degree in Nursing or advanced degree is…