RN Utilization Review: Care Coord & Compliance

Sentara Health; Central City (NE); On-site; USD 93,000 - 137,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Paid Time Off

Education Assistance

401k/403(b) with Match

Job summary

Sentara Health Plans Community Care is seeking an experienced Utilization Review Nurse in Norfolk, VA. The role covers prior authorization, retrospective reviews, and care coordination to ensure treatment aligns with medical policies and contracts.

The position requires RN licensure with a BSN preferred and at least 3 years of acute care experience. Familiarity with Milliman, NCQA, and Microsoft Office is preferred, with opportunities for bonuses and comprehensive benefits.

Qualifications

• BSN or higher preferred; RN is required.
• 3 years of acute care clinical experience required.
• Experience with utilization review, Milliman, and NCQA knowledge preferred.

Responsibilities

• Perform utilization management including prior authorization and retrospective review.
• Coordinate care and refer to medical directors as needed.
• Prepare and issue authorization/denial letters per criteria and contracts.

Skills

Utilization Review experience

Communication

Analytical skills

Facilitation

Prior authorization

Education

BSN (preferred)

Tools

Milliman

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Sentara Health Plans Community Care is seeking an experienced Utilization Review Nurse in Norfolk, VA. The role covers prior authorization, retrospective reviews, and care coordination to ensure treatment aligns with medical policies and contracts.

The position requires RN licensure with a BSN preferred and at least 3 years of acute care experience. Familiarity with Milliman, NCQA, and Microsoft Office is preferred, with opportunities for bonuses and comprehensive benefits.