Remote RN Claims Reviewer: Utilization & Post-Pay

Sentara Health; North Carolina; Remote; USD 93,000 - 132,000; Full time

Benefits offered by this job

Medical plan

Dental plan

Vision plan

401(k) matching

Paid time off

Parental leave

Education assistance

Student debt pay down

Life insurance

Job summary

Sentara Health Plans is hiring a Clinical Claims Reviewer/RN for a remote role. This full-time position involves utilization management and post-payment review across various care settings, with RN licensure and coding credentials under consideration.

The role offers remote opportunities across multiple states, including NC, VA, and others, with standard hours from 8am to 5pm EST, M-F. A BSN and 3 years acute care experience are required.

Qualifications

• RN license required (Compact or VA)
• BSN required
• 3 years of acute care clinical experience
• Utilization Review and Post Payment Review experience preferred
• Medical Coding certification within 1 year of hire
• Certified Professional Coder preferred

Responsibilities

• Perform utilization management reviews for inpatient, outpatient, concurrent and retrospective cases.
• Review provider post-payment inquiries and ensure coding accuracy per guidelines and policies

Skills

Verbal communication

Written communication

Interpersonal skills

Problem solving

Facilitation

Analytical skills

Education

Bachelor's Degree in Nursing

Job description

Sentara Health Plans is hiring a Clinical Claims Reviewer/RN for a remote role. This full-time position involves utilization management and post-payment review across various care settings, with RN licensure and coding credentials under consideration.

The role offers remote opportunities across multiple states, including NC, VA, and others, with standard hours from 8am to 5pm EST, M-F. A BSN and 3 years acute care experience are required.