Clinical Utilization Review Specialist - Case Management

01 Kaweah Delta Health Care District

Visalia (CA)

On-site

USD 42,000 - 62,000

Full time

6 days ago

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Job summary

Kaweah Health is seeking a Clinical UR Specialist in Case Management to support medical necessity reviews, data extraction, and discharge planning. The role collaborates with RN Case Management to monitor quality of patient care and coordinate services across the hospital and community resources.

Ideal candidates have LVN licensure in California, 1+ year of clinical experience, and experience with utilization review or coding.

Qualifications

CA LVN license required.
Degree in Human Services areas of Social Work, Psychology or other health-related fields with medical terminology or equivalence.
Minimum of one year of clinical experience (acute care preferred).
Utilization review and/or coding experience.
ED- Minimum of two years Case Management experience.

Responsibilities

Collect clinical data for quality and effectiveness of patient care.
Collaborate with Case Management team and other health care providers.
Perform Utilization Management to meet Case Management Goals: review data for medical necessity.
Refer variances to Case Management Committee and/or PI department.
Review cases for admission, continued stay, and resource utilization.
Assist discharge planning and placement in appropriate facilities.
Participate in Continuum of Care rounds.