Utilization Review RN, Care Coordination

Utilization Review RN, Care Coordination, Full-Time, Days

Locations: Greenbrae, CA

Time Type: Full time

Posted On: 17 Days Ago

Job Requisition : 13593 - AUTBD

ABOUT MARINHEALTH
Are you looking for a place where you are empowered to bring innovation to reality? Join Marin Health, an integrated, independent healthcare system with deep roots throughout the North Bay. With a world-class physician and clinical team, an affiliation with UCSF Health, an ever-expanding network of clinics, and a new state-of-the-art hospital, Marin Health is growing quickly.

Company: Marin General Hospital dba Marin Health Medical Center

Compensation Range: $66.03 - $99.04

Work Shift: Day Shift (United States of America)

Scheduled Weekly

Hours:

40

Job Description

Summary:


The Utilization Review Nurse is responsible for completion of admission, concurrent and retrospective reviews for designated health plans. This function includes appropriate application of standardized criteria and concurrent documentation. As appropriate, the UR nurse will assess for clinical stability and coordinate transfer back to Marin General for continued care when patients are admitted to non-contracted hospitals. The UR nurse is also responsible for initial RAC review prior to submission to Physician Advisor and will appeal medical necessity denials.

Job Requirements , Prerequisites and

Essential Functions:

EDUCATION:
Bachelor of Science degree in Nursing preferred

EXPERIENCE:
1. Three (3) or more years of experience in an acute patient care setting preferably in medical/surgical or critical care.
2. Substantial recent experience in utilization review and/or discharge planning in an acute care setting is strongly preferred.
3. Experience in applying evidence based criteria related to utilization management.
4. Experience using case management software.

LICENSURE AND

CERTIFICATIONS:


Registered Nurse Required at hire
Basic Life Support Required at hire

PREREQUISITE

SKILLS:


1. Must have the ability to read, write, and follow English verbal and written instructions, and have excellent oral and written communication, interpersonal, problem-solving, conflict resolution, presentation, time management, and positive personal influence and negotiation skills.
2. Able to carry out review function and access medical records.
3. Must have the ability to work independently with a minimum of direction, anticipate and organize work flow, prioritize and follow through on responsibilities.
4. Strong attention to detail and accuracy is required.
5. Must have the ability to work in a high volume case load environment and deal effectively with rapidly changing priorities.
6. Demonstrated ability to work constructively with a broad spectrum of health care professionals is required.
7. Proficient computer skills are required including use of Electronic Health Record and Microsoft Office Suite Products.

Reasonable accommodation(s) to qualified individuals with disabilities are available as part of the application step. If an accommodation is needed, please contact Human Resources at  or email Talent Acquisition to initiate the process.

At Marin Health, our top priority is the well-being of our employees, patients, and community. As such, we require all employees to receive necessary immunizations, including the measles, mumps, varicella, and seasonal flu vaccinations as a condition of employment and annually thereafter.

Marin Health is a diverse community of people with many different talents. We seek candidates whose work experience has prepared them to contribute to our professional, C.A.R.E.S standards (Communication, Accountability, Respect, Excellence, and Safety).