Per Diem Clinical Utilization Review Specialist

01 Kaweah Delta Health Care District

Visalia (CA)

On-site

USD 34,000 - 51,000

Full time

14 days+

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Job summary

Kaweah Health is seeking a Clinical Utilization Review Specialist in Visalia, CA to collaborate with RN Case Management and coordinate data-driven discharge planning. The role emphasizes data extraction from medical records, quality monitoring, and interdisciplinary teamwork to improve patient care outcomes.

Requirements include a CA LVN license, a related health-services degree, and at least one year of clinical data extraction experience.

Qualifications

CA LVN license is required.
Degree in Human Services areas of Social Work, Psychology or health-related fields preferred with medical terminology.
Experience extracting data from medical records; minimum one year of clinical experience.
ED – minimum of two years Case Management experience.

Responsibilities

Collects clinical data for RN to monitor quality of care and participates in interdisciplinary teams.
Reviews utilization data to determine medical necessity for assigned caseload and reports variances.
Reviews records using InterQual criteria for admission, continued stay, and resource use.
Coordinates discharge planning and referrals to ensure continuity of care.
Communicates with patient/family, physicians and providers; participates in Continuum of Care rounds.