Remote Utilization Review RN — Care Coordination

Sentara Health; Montgomery (AL); On-site; USD 93,000 - 137,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

Paid time off (vacation, sick, holiday

Discretionary annual bonus potential

Adoption, fertility and surrogacy bene

Job summary

Sentara Health Plans Community Care is seeking a Utilization Review Nurse in Montgomery, AL. The role focuses on utilization management, including prior authorizations, care coordination, and ensuring treatment meets criteria and policy standards.

The position requires RN licensure and at least 3 years of acute care experience. Proficiency with Microsoft Word, Excel, and Outlook is preferred. Sentara offers a comprehensive benefits package and potential bonuses.

Qualifications

• 3 years of acute care clinical experience is required.
• Registered Nurse (RN) license required.
• Proficiency with Microsoft Word, Excel and Outlook is preferred.

Responsibilities

• Conducts utilization management services including prior authorization, retrospective review and referrals.
• Executes pre-certification and care coordination for appropriateness of treatment.
• Ensures decisions align with CMS, state and policy criteria and medical standards.

Skills

Acute care experience

Care coordination

Microsoft Office Suite

Education

RN license

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Sentara Health Plans Community Care is seeking a Utilization Review Nurse in Montgomery, AL. The role focuses on utilization management, including prior authorizations, care coordination, and ensuring treatment meets criteria and policy standards.

The position requires RN licensure and at least 3 years of acute care experience. Proficiency with Microsoft Word, Excel, and Outlook is preferred. Sentara offers a comprehensive benefits package and potential bonuses.