Utilization Review RN II — Care Coordination Expert

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

Job summary

MarinHealth seeks an experienced Utilization Review Nurse to manage admission, concurrent and retrospective reviews using standardized criteria. You will coordinate transfers back to MarinHealth when patients are admitted to non-contracted facilities and escalate complex cases to the Medical Director as needed.

Responsibilities include RAC denial management, documentation in the EHR, and collaboration with Patient Financial Services to ensure medical necessity and timely appeals.

Qualifications

• BSN preferred and California RN license required at hire.
• Three or more years in an acute patient care setting.
• Utilization review and/or discharge planning experience.
• Experience using case management software and EHR.
• BLS certification at hire.

Responsibilities

• Perform admission reviews within 24 hours of notification.
• Conduct continued stay reviews and verify treatment plans.
• Assess patient stability and coordinate repatriation to MarinHealth.
• Submit RAC denials and appeals with Medical Director oversight.
• Maintain documentation in the EHR and support throughput.

Skills

Communication skills

Oral and written communication

Interpersonal skills

Problem solving

Time management

Negotiation

Electronic Health Record

Microsoft Office

Education

Bachelor of Science in Nursing

Tools

Electronic Health Record (EHR)

Microsoft Office

Job description

MarinHealth seeks an experienced Utilization Review Nurse to manage admission, concurrent and retrospective reviews using standardized criteria. You will coordinate transfers back to MarinHealth when patients are admitted to non-contracted facilities and escalate complex cases to the Medical Director as needed.

Responsibilities include RAC denial management, documentation in the EHR, and collaboration with Patient Financial Services to ensure medical necessity and timely appeals.