Utilization Review RN II - Elevate Patient Care

Marin General Hospital dba MarinHealth Medical Center; United States; On-site; USD 91,000 - 136,000; Full time

Job summary

MarinHealth is seeking a Utilization Review Nurse to perform admission, concurrent and retrospective reviews for designated health plans. The UR nurse will apply standardized criteria and document concurrently in the patient record.

The role requires assessing clinical stability and coordinating transfers back to Marin General for continued care when patients are admitted to non-contracted facilities. A BSN is preferred with 3+ years of acute care experience.

Qualifications

• Bachelor of Science degree in Nursing preferred.
• Three+ years in acute patient care setting.
• Utilization review and discharge planning experience preferred.
• Experience using case management software.

Responsibilities

• Perform admission, concurrent and retrospective reviews for designated health plans.
• Apply standardized criteria and document concurrently.
• Assess clinical stability and coordinate transfers back to Marin General for continued care when patients are admitted to non-contracted hospitals.
• Review denials and appeal medical necessity denials.
• Escalate cases to Medical Director to ensure appropriate patient care.

Skills

Communication skills

Clinical reasoning

Team collaboration

Education

Bachelor of Science in Nursing

Tools

Electronic Health Record

Microsoft Office

Job description

MarinHealth is seeking a Utilization Review Nurse to perform admission, concurrent and retrospective reviews for designated health plans. The UR nurse will apply standardized criteria and document concurrently in the patient record.

The role requires assessing clinical stability and coordinating transfers back to Marin General for continued care when patients are admitted to non-contracted facilities. A BSN is preferred with 3+ years of acute care experience.