Remote RN: Clinical Claims & Utilization Reviewer

Sentara Health; Utah; A distancia; USD 93.000 - 132.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, vision

Paid time off

401k/retirement plan

Life and disability insurance

Education assistance

Student debt payoff

Flexible work options

Descripción de la vacante

Sentara Health Plans in Norfolk, VA seeks a Clinical Claims Reviewer/RN for a remote-friendly, full-time role. You will conduct comprehensive pre- and post-payment claim reviews, including authorization reviews across inpatient and outpatient cases, while ensuring compliance with policies and regulatory standards.

The ideal candidate holds a BSN, 3 years of acute care experience, and a coders' background with NCQA/MCG familiarity.

Formación

• RN licensure in Virginia or compact state.
• Certified Professional Coder (CPC) preferred.
• 3 years of acute care clinical experience required.

Responsabilidades

• Perform utilization management with pre- and post-payment claim reviews and authorization reviews for inpatient/outpatient cases.
• Ensure accurate coding and apply CMS/MCG guidelines; respond to post-payment inquiries and provider reconsiderations.

Conocimientos

Verbal communication

Written communication

Interpersonal skills

Problem solving

Analytical thinking

Educación

Bachelor’s Degree in Nursing

Descripción del empleo

Sentara Health Plans in Norfolk, VA seeks a Clinical Claims Reviewer/RN for a remote-friendly, full-time role. You will conduct comprehensive pre- and post-payment claim reviews, including authorization reviews across inpatient and outpatient cases, while ensuring compliance with policies and regulatory standards.

The ideal candidate holds a BSN, 3 years of acute care experience, and a coders' background with NCQA/MCG familiarity.