Remote RN Clinical Claims Reviewer

Sentara Health; Kansas; Remote; USD 84,000 - 103,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k/403B with Employer Match

Paid Time Off

Job summary

Sentara Health Plans is seeking a Clinical Claims Reviewer/RN for a remote, full-time role. Responsibilities include utilization management, pre/post payment claim reviews, and provider inquiries within established guidelines. Requires RN, BSN, and 3 years acute care experience.

Remote opportunities are available across multiple states, with competitive benefits and salary range. Join a trusted healthcare organization focused on quality and patient safety.

Qualifications

• BSN and active RN license required.
• Minimum 3 years acute care clinical experience.
• Utilization review and post-payment review experience preferred.

Responsibilities

• Perform utilization management and claim reviews pre/post payment, including authorization for inpatient, outpatient, and retrospective cases.
• Ensure compliance with health plan policy and regulatory standards; communicate review decisions to providers.

Skills

Utilization mgmt

Claim review

Regulatory knowledge

Communication skills

Education

Bachelor's in Nursing

RN License

Tools

MCG guidelines

CMS guidelines

Job description

Sentara Health Plans is seeking a Clinical Claims Reviewer/RN for a remote, full-time role. Responsibilities include utilization management, pre/post payment claim reviews, and provider inquiries within established guidelines. Requires RN, BSN, and 3 years acute care experience.

Remote opportunities are available across multiple states, with competitive benefits and salary range. Join a trusted healthcare organization focused on quality and patient safety.