Remote Utilization Review Nurse — RN

Sentara Health; Minnesota; Presencial; USD 93.000 - 137.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Discretionary bonus opportunity

Comprehensive benefits package

Descripción de la vacante

Sentara Health Plans Community Care is seeking a licensed Utilization Review Nurse to join our team. The RN will perform prior authorization, care coordination, and reviews to ensure clinical appropriateness and policy alignment.

The role requires RN licensure and at least 3 years of acute care experience; familiarity with CMS/state criteria is a plus. We offer a comprehensive benefits package and potential discretionary bonus.

Formación

• Registered Nurse (required).
• 3 years of acute care clinical experience (required).
• Microsoft suite (Word, Excel, Outlook) (preferred).

Responsabilidades

• Performs utilization management activities including prior authorizations and retrospective reviews.
• Coordinates care and reviews approvals/denials with medical director as needed.
• Ensures decisions align with CMS, state, and medical policy criteria and contracts.

Conocimientos

Registered Nurse

Acute care

Care coordination

Prior authorization

Herramientas

Microsoft Excel

Microsoft Word

Microsoft Outlook

Descripción del empleo

Sentara Health Plans Community Care is seeking a licensed Utilization Review Nurse to join our team. The RN will perform prior authorization, care coordination, and reviews to ensure clinical appropriateness and policy alignment.

The role requires RN licensure and at least 3 years of acute care experience; familiarity with CMS/state criteria is a plus. We offer a comprehensive benefits package and potential discretionary bonus.