Utilization Review RN, Care Coordination, Full-Time, Days - Marinhealth : Job Details

ABOUT MARINHEALTHAre you looking for a place where you are empowered to bring innovation to reality? Join MarinHealth, an integrated, independent healthcare system with deep roots throughout the North Bay. With a world-class physician and clinical team, an affiliation with UCSF Health, anever-expanding network of clinics, and a new state-of-the-art hospital, MarinHealth is growing quickly. MarinHealth comprises MarinHealth Medical Center, a 327-bed hospital in Greenbrae, and 55 primary care and specialty clinics in Marin, Sonoma, and Napa Counties. We attract healthcare's most talented trailblazers who appreciate having the best of both worlds: the pioneering medicine of an academic medical center combined with an independent hospital's personalized, caring touch. MarinHealth is already realizing the benefits of impressive growth and has consistently earned high praise and accolades, including being Named One of the Top 250 Hospitals Nationwide by Healthgrades, receiving a 5-star Ranking for Overall Hospital Quality from the Centers for Medicare and Medicaid Services, and being named the Best Hospital in San Francisco/Marin by Bay Area Parent, among others. Company: Marin General Hospital dba MarinHealth Medical CenterCompensation Range:$66.03 - $99.04Work Shift:Day Shift (United States of America)Scheduled Weekly Hours:40Job Description 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.Job Requirements, Prerequisites and Essential Functions:EDUCATIONBachelor of Science degree in Nursing preferredEXPERIENCE1. Three (3) or more years of experience in an acute patient care setting preferably in medical/surgical or critical care.2. Substantial recent experience in utilization review and/or discharge planning in an acute care setting is strongly preferred.3. Experience in applying evidence based criteria related to utilization management.4. Experience using case management softwareLICENSURE AND CERTIFICATIONSRegistered Nurse Required at hireBasic Life Support Required at hirePREREQUISITE SKILLS1. Must have the ability to read, write, and follow English verbal and written instructions, and have excellent oral and written communication, interpersonal, problem-solving, conflict resolution, presentation, time management, and positive personal influence and negotiation skills.2. Able to carry out review function and access medical records.3. Must have the ability to work independently with a minimum of direction, anticipate and organize work flow, prioritize and follow through on responsibilities.4. Utilization review/discharge planning services appropriate to patients with complex5. Strong attention to detail and accuracy is required.6. Must have the ability to work in a high volume case load environment and deal effectively with rapidly changing priorities.7. Demonstrated ability to work constructively with a broad spectrum of health care professionals is required.8. Must be assertive and creative in problem solving, system planning and management.9. Proficient computer skills are required including use of Electronic Health Record. Microsoft Office Suite Products.Reasonable accommodation(s) to qualified individuals with disabilities are available as part of the application step. If an accommodation is needed, please contact Human Resources at 415-###-#### or email [email protected] to initiate the process.MarinHealth is a diverse community of people with many different talents. We seek candidates whose work experience has prepared them to contribute to our professional, C.A.R.E.S standards (Communication, Accountability, Respect, Excellence, and Safety) . These behavioral standards help us create a healing environment for patients and colleagues alike. By committing to them and holding ourselves accountable, we can build trust and ensure clear communication.At MarinHealth, our top priority is the well-being of our employees, patients, and community. As such, we require all employees to receive necessary immunizations, including the measles, mumps, varicella, and seasonal flu vaccinations as a condition of employment and annually thereafter. Additionally, the continued recommendation to obtain a COVID + booster vaccination status. We understand that some individuals may require medical or religious exemptions from these requirements, and we remain committed to prioritizing the health and safety of all. Thank you for helping us in our efforts to maintain a healthy and safe environment.The compensation for this role listed on this posting is in compliance with applicable law. The selected candidate's compensation will be determined based on the individual's skills, experience, internal/market equity factors, and qualifications. This posted minimum and maximum range represents the minimum and maximum of what we reasonably expect to compensate for the position. Furthermore, all compensation decisions are ultimately determined in accordance with our compensation philosophy. Compensation for positions covered by collective bargaining agreements are governed by the agreements in the aforementioned document.