Utilization Review Nurse II - Lead Care Optimization

MarinHealth; Greenbrae Boardwalk (CA); On-site; USD 91,000 - 136,000; Full time

Job summary

MarinHealth seeks an experienced Utilization Review Nurse to perform admission, concurrent, and retrospective reviews for designated health plans. This role ensures appropriate criteria are applied and coordinates care transfers as needed within MarinHealth.

The UR nurse will handle initial RAC reviews, escalate to Medical Director as needed, and review denials with the case management team. A BSN and active RN license are required.

Qualifications

• Bachelor of Science in Nursing preferred.
• Active RN license required at hire.
• Three+ years in acute care setting preferred.

Responsibilities

• Perform admission, concurrent and retrospective reviews for designated health plans.
• Assess clinical stability and coordinate transfers back to MarinHealth.
• Submit RAC reviews and appeal denials as required.

Skills

RN clinical care

Communication

Team collaboration

Critical thinking

Education

Bachelor of Science in Nursing

Registered Nurse license

Tools

Electronic Health Records

Microsoft Office

Job description

MarinHealth seeks an experienced Utilization Review Nurse to perform admission, concurrent, and retrospective reviews for designated health plans. This role ensures appropriate criteria are applied and coordinates care transfers as needed within MarinHealth.

The UR nurse will handle initial RAC reviews, escalate to Medical Director as needed, and review denials with the case management team. A BSN and active RN license are required.