Utilization Review RN II, Care Coordination

## Utilization Review RN II, Care Coordination, Full-Time, Days Apply locations:
Greenbrae, CAtime type:
Full time posted on:
Posted 2 Days Agojob requisition :
14777 - 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. Marin Health comprises Marin Health Medical Center, a 327-bed hospital in Greenbrae, and 55 primary care and specialty clinics in Marin, Sonoma, and Napa Counties.

We attract healthcare’s most talented trailblazers who appreciate having the best of both worlds: the pioneering medicine of an academic medical center combined with an independent hospital's personalized, caring touch.

Marin Health is already realizing the benefits of impressive growth and has consistently earned high praise and accolades, including being Named One of the Top 250 Hospitals Nationwide by Health grades, receiving a 5-star Ranking for Overall Hospital Quality from the Centers for Medicare and Medicaid Services, and being named the Best Hospital in San Francisco/Marin by Bay Area Parent, among others.
** Company:
** Marin General Hospital dba Marin Health Medical Center
** Compensation Range:**$66.03 - $99.04
*
* Work Shift:

** 10 Hour (days) (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.

Denials submitted to the case management department from Patient Financial Services will be reviewed to determine if the medical record has sufficient medical necessity documentation prior to a written appeal. The UR nurse will escalate cases to the Medical Director (as necessary) to ensure the provision of appropriate and effective patient care.
** 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. Utilization review/discharge planning services appropriate to patients with complex  
5.…