ABOUT MARINHEALTH
Are 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, an ever-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 Center

Compensation Range:

$28.81 - $43.21

Work Shift:

8 Hour (days) (United States of America)

Scheduled Weekly Hours:

40

Job Description Summary:

JOB SUMMARY: Under the supervision of Manager of Care Coordination, the Utilization Management Specialist role performs diversified non-licensed functions to support the Utilization Management Team. The UM Specialist communicates with review organizations, vendors, providers and other external customers to satisfy utilization management functions to ensure patient stays and services are authorized. The UM Specialist updates treatment authorizations, documents clinical denials (concurrent and retrospective) and processes review requests. The UM Specialist collaborates with all members of the care team and documents their activities within the patient record for review.

Job Requirements, Prerequisites and Essential Functions:

JOB SPECIFICATIONS:

               A.       EDUCATION

High School graduate or equivalent, A.A degree in Business /Health Related field or equivalent experience in a health care setting required

              B.       EXPERIENCE

Proficiency in medical terminology, Experience in commercial and government insurance, financial counseling or registration

Minimum of 2 years of job-related experience in a health care setting

Proficiency with electronic health record (EHR) and other care management applications i.e., EPIC

               C.        PREREQUISITE SKILLS

Basic knowledge of medical terminologies Knowledge of medical record documentation application processes Solid communication and interpersonal skills to communicate effectively with all levels of staff verbally and in writing Ability to carry out instruction provided in written or oral Ability to manage, set priorities and operate with minimal direct supervision and can work effectively under pressure

LICENSE/REGISTRATION/CERTIFICATION:

1.  None

PRIMARY CUSTOMER SERVED (Age Specific Criteria):

(   )  This position is not a patient care position, and as such, this section does not apply.

(   )  Infants - Birth up to 1 year

(   )  Adolescents - 12 up to 18 years

(   )  Toddlers - 1 up to 3 years            

(   )  Early Adults - 18 up to 45 years

(   )  Preschool Children - 3 up to 6 years

(   )  Middle Adults - 45 up to 61 years

(   )  School - Age Children 6 up to 12 years

(   )  Late Adults - 61 up to 80 years

(   )  Late, Late Adults - 80 years and up

Employees in this position must be able to demonstrate the knowledge and skills necessary to provide care and/or service based on the physical, psycho/social, educational, safety, and related criteria appropriate to the age of the patients served in his/her assigned service area.

PATIENT PRIVACY (HIPAA Compliance):

(  )   Employees in this position do not have access to protected health information.

(x )   Employees in this position have access to protected health information.  The protected health information a person in this position can access includes demographics, date of service, insurance/billing, medical record summary information, and all other information that may be contained in patient records.  This position requires patient health information to perform the functions outlined as part of this position description.