Utilization Review Registered Nurse (RN), Care Coordination, Full Time, Days

Come and be a part of our healing team at the award-winning MarinHealth! Ranked in the top 3% of general hospitals in the country, we have made great strides since returning to our roots as an independent hospital. As Marin County’s only acute hospital and a vital resource for a wide range of essential health care services, it is our mission—and our passion—to excel in every medical specialty. We attract the finest physicians and employees who appreciate having the best of both worlds: the resources and medical sophistication of an academic medical center combined with the personalized, caring touch of an independent hospital. We have an exceptionally collaborative team that adheres to the highest service excellence standards to ensure that we deliver world-class, personalized care to patients. Our Joint-Commission accredited hospital has won numerous awards and certifications in delivering best-in-class health care in the San Francisco Bay Area.

WHAT WE OFFER

MarinHealth offers a generous suite of employee benefits, which includes a comprehensive and rich health benefits program (medical, dental, vision and prescription plans). Our robust Wellness @ Work program (e.g. onsite health & fitness classes, discounts, etc) also promotes a healthier lifestyle for employees and to support you on your Healthy Healer journey. Other benefits include, but are not limited to, a 403(b) contribution plan and company-funded retirement plan, life insurance, vacation, holiday and sick leave, which you will start accruing immediately. Our benefits are highly competitive and considered to be one of the best in the Bay Area! Find your healing place at MarinHealth.

External hires must pass a background check and medical screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with federal, state and local laws. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classifications protected by federal, state & local laws.

JOB 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.