RN Utilization Review & Care Coordination

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

Benefits offered by this job

Medical, Dental, Vision plans

401k with Employer Match

Paid Time Off and Sick Leave

Tuition Assistance – $5,250/year

Job summary

Sentara Health Plans Community Care is seeking an Utilization Review Nurse in Norfolk, VA. You will perform prior authorizations, retrospective reviews, and care coordination to ensure appropriate treatment per policy and contracts.

The role requires an RN license with a BSN preferred and 3 years of acute care experience. Proficiency in Microsoft Office and familiarity with Milliman/NCQA is a plus. Team collaboration and strong communication are essential.

Qualifications

• RN license required.
• 3 years acute care clinical experience.
• Utilization Review experience preferred.
• Milliman knowledge preferred.
• NCQA knowledge preferred.

Responsibilities

• Perform prior authorization and utilization review duties.
• Coordinate care and ensure treatment aligns with policies.
• Prepare and deliver written or verbal approvals/denials.
• Review provider requests requiring authorization and communicate outcomes.
• Ensure compliance with CMS, state, and NCQA criteria.

Skills

Communication skills

Problem-solving

Facilitation

Analytical skills

Microsoft Office

Education

BSN (preferred)

Tools

Microsoft Office

Job description

Sentara Health Plans Community Care is seeking an Utilization Review Nurse in Norfolk, VA. You will perform prior authorizations, retrospective reviews, and care coordination to ensure appropriate treatment per policy and contracts.

The role requires an RN license with a BSN preferred and 3 years of acute care experience. Proficiency in Microsoft Office and familiarity with Milliman/NCQA is a plus. Team collaboration and strong communication are essential.