Remote Utilization Review RN: Care Management Expert

Sentara Health; Virginia; Hybrid; USD 90,000 - 136,000; Full time

Benefits offered by this job

Medical benefits

Dental & Vision

PTO & Sick Leave

Parental leave

Disability insurance

Life Insurance

401k match

Tuition assistance

Student debt pay down

Pet insurance

Legal resources plan

Annual bonus eligibility

Job summary

Sentara Health is seeking a Remote Utilization Review Registered Nurse based in Virginia. The role focuses on utilization review and prior authorization for inpatient and outpatient cases, with emphasis on upholding regulatory criteria and documenting clinical information.

The ideal candidate has a Virginia RN license, 3+ years of acute care nursing, and 3 years in case management, with strong verbal and written communication skills and computer proficiency.

Qualifications

• RN licensed in Virginia; notable clinical experience preferred.
• Minimum 3 years nursing experience in acute care.
• 3 years case management experience preferred.

Responsibilities

• Perform prior authorization for inpatient and outpatient reviews (initial and concurrent).
• Assess utilization to determine appropriate treatment setting and regulatory compliance.
• Communicate relevant clinical information in written and/or verbal form.

Skills

Utilization review

Registered Nurse (RN)

Case management

Verbal communication

Written communication

Critical thinking

Computer skills

Education

RN Diploma

BSN

Job description

Sentara Health is seeking a Remote Utilization Review Registered Nurse based in Virginia. The role focuses on utilization review and prior authorization for inpatient and outpatient cases, with emphasis on upholding regulatory criteria and documenting clinical information.

The ideal candidate has a Virginia RN license, 3+ years of acute care nursing, and 3 years in case management, with strong verbal and written communication skills and computer proficiency.