Remote RN: Clinical Claims & Utilization Reviewer

170 Sentara Health Administration, Inc.; Virginia; Híbrido; USD 93.000 - 132.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, Dental, Vision plans

401k/403B with Employer Match

Paid Time Off

Descripción de la vacante

Sentara Health Plans seeks an RN Clinician to perform utilization management and claim reviews across inpatient and outpatient settings. The role supports pre/post payment reviews and authorization assessments, ensuring compliance with policy and regulatory standards.

The ideal candidate has an RN license, BSN, and 3 years of acute care experience. CDI/CPC background is a plus, with remote work options available in several states.

Formación

• RN Clinician with clinical nursing experience.
• Experience in utilization review and post payment review preferred.
• Knowledge of NCQA, MCG guidelines, and CMS policies is beneficial.

Responsabilidades

• Perform utilization management review pre and post payment across inpatient/outpatient cases.
• Handle provider post-payment inquiries and consider referrals to Medical Directors as needed.
• Ensure coding accuracy per CMS guidelines and coding policies.

Conocimientos

RN Clinician

Utilization Review

Post Payment Review

Medical Coding

Educación

Bachelor's Degree in Nursing

RN License

Descripción del empleo

Sentara Health Plans seeks an RN Clinician to perform utilization management and claim reviews across inpatient and outpatient settings. The role supports pre/post payment reviews and authorization assessments, ensuring compliance with policy and regulatory standards.

The ideal candidate has an RN license, BSN, and 3 years of acute care experience. CDI/CPC background is a plus, with remote work options available in several states.