RN Utilization Review & Care Coordination

Sentara Health; Pennsylvania; On-site; USD 93,000 - 137,000; Full time

Benefits offered by this job

Adoption, Fertility and Surrogacy Reim

Emergency Backup Care

Long-Term, Short-Term Disability, and

Life Insurance

Legal Resources Plan

Discretionary bonus eligibility

Job summary

Sentara Health Plans Community Care in Pennsylvania is seeking a Utilization Review Nurse. The RN will perform utilization management activities under licensure, including prior authorization, care coordination, and pre-certification to ensure appropriate treatment and policy compliance.

The role requires an RN with at least 3 years of acute care experience; proficiency with Word, Excel and Outlook is preferred. Eligible for full-time benefits and the posted salary range.

Qualifications

• RN required.
• Minimum 3 years of acute care clinical experience.
• Microsoft Office suite experience preferred.

Responsibilities

• Perform utilization management within licensure, including pre-certification and prior authorization.
• Conduct retrospective reviews and medical director referrals.
• Communicate approval or denial letters to members/providers.
• Coordinate care for appropriateness of treatment and ensure compliance with policy.

Skills

RN

Care coordination

Prior authorization

Medical policy

Education

Registered Nurse (RN) license

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Sentara Health Plans Community Care in Pennsylvania is seeking a Utilization Review Nurse. The RN will perform utilization management activities under licensure, including prior authorization, care coordination, and pre-certification to ensure appropriate treatment and policy compliance.

The role requires an RN with at least 3 years of acute care experience; proficiency with Word, Excel and Outlook is preferred. Eligible for full-time benefits and the posted salary range.