Remote Utilization Review Nurse | RN Care Coordination

Sentara Health; Heber (UT); On-site; USD 93,000 - 137,000; Full time

Benefits offered by this job

Fertility reimbursement

Emergency backup care

Disability plans

Life insurance

Legal resources plan

Annual discretionary bonus

Job summary

Sentara Health Plans Community Care is seeking a Utilization Review Nurse. The RN will perform utilization management including prior authorization, retrospective review, and care coordination to ensure appropriate treatment and policy compliance.

Responsibilities include pre-certification, eligibility checks, and issuing approvals/denials with proper documentation, while adhering to CMS and state criteria for accreditation.

Qualifications

• Active RN license required.
• Minimum of 3 years acute care clinical experience.
• Proficiency with Microsoft Word, Excel and Outlook preferred.
• Experience in utilization review or care coordination a plus.

Responsibilities

• Performs utilization management including prior authorization and retrospective review.
• Manages pre-certification and care coordination for treatment appropriateness.
• Executes member/provider approvals or denials and related letters.
• Ensures decisions align with CMS/state criteria and medical policy.

Skills

Acute care experience

Care coordination

Prior authorization

Education

Registered Nurse (RN) license

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Sentara Health Plans Community Care is seeking a Utilization Review Nurse. The RN will perform utilization management including prior authorization, retrospective review, and care coordination to ensure appropriate treatment and policy compliance.

Responsibilities include pre-certification, eligibility checks, and issuing approvals/denials with proper documentation, while adhering to CMS and state criteria for accreditation.