Impactful RN: Utilization Review & Care Coordination

Sentara Health; United States; Remote; USD 75,000 - 110,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

Adoption, Fertility and Surrogacy Reim

Paid Time Off and Sick Leave

Paid Parental & Family Caregiver Leave

Emergency Backup Care

Disability plans

Life Insurance

401k/403B with Employer Match

Tuition Assistance – $5,250/year

Student Debt Pay Down – $10,000

Pet Insurance

Legal Resources Plan

Job summary

Sentara Health Plans Community Care in Norfolk, VA is seeking a Utilization Review Nurse to support utilization management, prior authorization, retrospective review, and care coordination for appropriate treatment decisions. Candidates must hold an RN license with at least 3 years of acute care experience; BSN preferred.

Milliman and NCQA knowledge are a plus, with strong communication and analytical skills essential for success.

Qualifications

• Must hold an RN license with 3 years of acute care experience.
• BSN preferred.
• Milliman and NCQA knowledge is a plus.
• Proficient in MS Office and strong communication skills.

Responsibilities

• Perform prior authorization, retrospective review, and care coordination.
• Assess requests for services requiring authorization and ensure policy compliance.
• Provide written and verbal notifications to members and providers.

Skills

Utilization review

Care coordination

Communication skills

Problem-solving

Education

BSN (preferred)

RN licensure (required)

Tools

Microsoft Word

Excel

Outlook

Job description

Sentara Health Plans Community Care in Norfolk, VA is seeking a Utilization Review Nurse to support utilization management, prior authorization, retrospective review, and care coordination for appropriate treatment decisions. Candidates must hold an RN license with at least 3 years of acute care experience; BSN preferred.

Milliman and NCQA knowledge are a plus, with strong communication and analytical skills essential for success.