Utilization Review RN II: Care Coordination Pro

Marin General Hospital; California, Northern (MO, KY); Hybrid; USD 70,000 - 110,000; Full time

Job summary

MarinHealth is seeking a Utilization Review Nurse II to perform admission, concurrent and retrospective reviews for designated health plans in a 40-hour week on days at Greenbrae, CA. The role requires a BSN preferred, 3+ years of acute care experience, and experience with case management software and Electronic Health Records.

In this role you will assess clinical stability, coordinate transfers for continued care, and collaborate with a multidisciplinary team to ensure medical necessity

Qualifications

• Registered Nurse with BSN preferred and current licensure.
• Three+ years of acute care experience, preferably medical/surgical or critical care.
• Experience in utilization review, discharge planning, and case management software.
• Proficient in English with strong written and verbal communication.

Responsibilities

• Complete admission, concurrent, and retrospective reviews for designated health plans.
• Apply criteria, document assessments, and coordinate transfers as needed.
• Escalate to Medical Director to ensure appropriate patient care when necessary.
• Review denials and prepare written appeals with medical record documentation.

Skills

RN

Utilization review

Discharge planning

Case management software

English communication

Education

BSN preferred

Tools

Electronic Health Record

Microsoft Office

Job description

MarinHealth is seeking a Utilization Review Nurse II to perform admission, concurrent and retrospective reviews for designated health plans in a 40-hour week on days at Greenbrae, CA. The role requires a BSN preferred, 3+ years of acute care experience, and experience with case management software and Electronic Health Records.

In this role you will assess clinical stability, coordinate transfers for continued care, and collaborate with a multidisciplinary team to ensure medical necessity