Utilization Review & Case Management Specialist

Kaweah Delta Health Care District; Visalia (CA); On-site; USD 65,000 - 85,000; Full time

Job summary

Kaweah Health in Visalia, CA seeks a Clinical UR Specialist to support RN Case Management. You will collect clinical data, monitor quality measures, and assist with safe discharge planning in collaboration with a multidisciplinary team.

The role emphasizes utilization management, documentation of medical necessity, and coordination of care with patients, families and providers. Experience in case management is preferred.

Qualifications

• Experience extracting data from a medical record.
• Minimum of one year of clinical experience (acute care preferred).
• Preferred: utilization review and/or coding experience.
• ED: minimum two years Case Management experience.

Responsibilities

• Uses quality of care results to initiate changes in patient care practices and collect clinical data for RN review.
• Performs Utilization Management to determine medical necessity for the caseload and ensure inpatient records are current.
• Reviews records for admission and continued stay using InterQual criteria for appropriateness of care.
• Collaborates with patients, families, physicians and other providers to coordinate discharge planning and long-term care placements.

Skills

Data extraction from medical records

Clinical experience

Interdisciplinary collaboration

Education

Degree in Human Services fields (Social Work, Psychology or related) with medical terminology

Tools

InterQual Severity of Illness

Intens ity of Service

Job description

Kaweah Health in Visalia, CA seeks a Clinical UR Specialist to support RN Case Management. You will collect clinical data, monitor quality measures, and assist with safe discharge planning in collaboration with a multidisciplinary team.

The role emphasizes utilization management, documentation of medical necessity, and coordination of care with patients, families and providers. Experience in case management is preferred.