Team Peak Performers: UM Department Utilization Review Specialist (URS) Team

Cook Children's Health Plan Utilization Management (UM) URS team goes above and beyond in the areas of quality, safety, and service for our patients, families, and each other. Almost a year ago, the URS staff were challenged with a workforce reduction, which cut the team by less than half. The drastic change was hard; however, this team has shown resiliency by using this as an opportunity to come together as a team and face challenges, problem solve and recover from various challenging scenarios. 

Since then, the team has begun to be cross-trained in all areas of UM in order to keep the department running as smoothly and seamlessly as before. Everyone has been optimistic and sees an opportunity to learn from a task, whether the outcome is success or failure. This in turn has also allowed for many SOP updates and process improvements across the UM department.

In the midst of all this change, many team members have also taken on extra responsibilities or worked extra hours to support the change and to help our small group of 10 to process as many Authorizations as possible. The team works overtime, takes on additional projects, is involved in all aspects of Utilization Review from the moment an Authorization is processed, approved, or denied. They’re even involved in the scheduling of Peer to Peer for our Medical Directors day in and day out. The collaboration with UM leadership has also improved and communication has grown in many ways which has allowed for so much growth in the department. 

The team has been flexible, reliable and resilient! I couldn’t ask to be part of a better team and I appreciate all the hard work by all. I believe they deserve to be recognized for all they have done and continue to do to uphold Cook Children's Promise!