Remote RN Clinical Claims Reviewer | Utilization & Appeals

Sentara Health; South Carolina; Remoto; USD 93.000 - 132.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, Dental, Vision plans

401(k)/403(b) with employer match

Paid time off

Tuition assistance

Descrizione del lavoro

Sentara Health Plans is seeking a Clinical Claims Reviewer/RN for remote work. The role involves evaluating utilization management, reviewing pre/post payment claims, and ensuring adherence to policy across multiple states. A BSN and active RN license are required, with 3 years of acute care experience.

Remote opportunities are available nationwide. The compensation reflects a strong health plan benefit package and opportunities for professional growth within Sentara Health Plans.

Competenze

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

Mansioni

• Review claims pre/post payment and authorization for inpatient/outpatient cases.
• Ensure compliance with BOI, NCQA, CMS, DMAS and health plan policies.

Conoscenze

RN Clinician

Utilization management

Post-payment review

Regulatory compliance

Strong communication

Formazione

Bachelor's Degree in Nursing

Strumenti

MCG

NCQA knowledge

Descrizione del lavoro

Sentara Health Plans is seeking a Clinical Claims Reviewer/RN for remote work. The role involves evaluating utilization management, reviewing pre/post payment claims, and ensuring adherence to policy across multiple states. A BSN and active RN license are required, with 3 years of acute care experience.

Remote opportunities are available nationwide. The compensation reflects a strong health plan benefit package and opportunities for professional growth within Sentara Health Plans.