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Clinical UR Specialist
| Company | Kaweah Health |
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| Location | Visalia, CA, USA |
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| Salary | $30.17 – $45.26 |
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| Type | Full-Time |
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| Degrees | Bachelor’s |
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| Experience Level | Junior |
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Requirements
- CA LVN license
- Experience in extracting data from a medical record
- Minimum of one year of clinical experience (acute care preferred)
Responsibilities
- Uses the results of quality of care/performance improvement activities to initiate changes in patient care practices
- Collects clinical data for the RN to monitor quality and effectiveness of patient care
- Identifies aspects of care that are important for quality monitoring
- Participates in interdisciplinary teams
- Reviews and records utilization review data to determine medical necessity for assigned caseload
- Refers to Case Management team any variances that relate to concurrent review of the medical record
- Reviews medical records for admission and continued stay utilizing InterQual Severity of Illness and Intensity of Service
- Issues a non-certification letter as directed by the Case Management Committee
- Informs the Case Management Team and attending physician of any questionable or denied cases
- Collaborates and communicates with the patient/resident, family, physician, and other health care providers
- Facilitates and coordinates placement of patients in appropriate long-term care facilities
- Assists case management team with discharge planning services
- Participates in Continuum of Care rounds
- Performs special audits/reports as required by the Case Management Team
- Responsible for maintaining a safe workplace for the protection of the patient, staff and visitors
- Assumes responsibility for the implementation of each individual patient program
- Participates consistently in team conferences concerning the person served
- Monitors the patient/family response to treatment and determines need for intervention and/or referral
- Participates in training of all newly hired Care Coordination staff
- Evaluates for efficient use of financial and personnel resources
Preferred Qualifications
- Degree in Human Services areas of Social Work, Psychology or other health-related fields with medical terminology or equivalence
- Utilization review and/or coding experience
