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705 Broad St. Box 90496
Durham, NC 27705
Phone: (919) 684-5600
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Duke University Job Description

QUALITY & UTILIZATION REVIEW COORD

Job Code: 2058
FLSA: E
Job Level: 10
Revised Date: 12/01/2007
Job Family: JF 32

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Occupational Summary

Perform a variety of duties associated with the Quality and Utilization Management Program to include the review of medical care of individuals using established criteria, the design of review and reporting procedures, and documentation of systematic review plans.

Work Performed

Review process and outcome of medical care by comparing actual care of individual patients with criteria of care established by medical staff of the appropriate medical service; identify potential problems and potential liabilities related to the quality of patient care.

Review information in medical record; obtain and review information from patient, physician and other participants in the care of patient; determine whether care of patient is an exception to established criteria for the diagnoses and problems that apply to that patient.

Discuss with the patient's physician and/or the appropriate quality assurance representative apparent departure from established criteria; report review findings to the utilization and quality assurance committees in accordance with procedures established by the medical staff for documenting systematic reviews of medical care. Assist the medical staff in the design of reviewing and reporting procedures that will serve the purposes of quality assurance and cost containment; determine the validity and appropriateness of nonpayment of claims by patients or outside agencies based on criteria; make appropriate recommendations to the medical staff.

Assist medical staff in coordinating review activities of the service with the review activities of other services.

Report the appropriate personnel conditions which are external to the scope of direct responsibilities and control of the medical staff that appear to be adversely affecting either the quality or cost of patient care.

Prepare statistics and special reports related to quality and utilization issues at the request of physicians or at the request of a quality assurance representative.

Perform other related duties incidental to the work described herein. The above statements describe the general nature and level of work being performed by individuals assigned to this classification. This is not intended to be an exhaustive list of all responsibilities and duties required of personnel so classified.

 

Required Qualifications at this Level

Education/Training:

Work requires graduation form an accredited Bachelors of Science in Nursing, Associate Degree in Nursing or Nursing Diploma program. Requires State of North Carolina license.

 

Experience:

Work requires no previous experience.

OR AN EQUIVALENT COMBINATION OF RELEVANT EDUCATION AND/OR EXPERIENCE

 

Skills:

N/A

 

The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.


Essential Physical Job Functions

Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.