Kaweah Health is a publicly owned, community healthcare organization that provides comprehensive health services to the greater Visalia area in central California. The Clinical UR Specialist works in collaboration with RN Case Management staff to gather clinical data to monitor quality and effectiveness of patient care. Assists with planning and execution of safe discharge plan in a timely manner while working in collaboration with the multi-disciplinary team. Required qualifications include a CA LVN license, experience in extracting data from medical records, and a minimum of one year of clinical experience (acute care preferred). Preferred qualifications include a degree in Human Services areas such as Social Work, Psychology or other health-related fields with medical terminology or equivalence, and utilization review and/or coding experience. Responsibilities include using quality of care/performance improvement results to initiate changes in patient care practices, collecting clinical data for RN monitoring, participating in interdisciplinary teams, performing utilization management to meet case management goals, reviewing medical records for admission and continued stay appropriateness, issuing non-certification letters as directed, collaborating and communicating with patients, families, physicians, and healthcare providers, facilitating patient placement and discharge planning, participating in continuum of care rounds, performing audits/reports, maintaining workplace safety, and supporting Kaweah Health values and teamwork. Additional duties include program liaison responsibilities for inpatient rehabilitation, training new care coordination staff, evaluating resource use, and performing other assigned duties.
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