RN Utilization Review | Care Coordination & Authorizations

Sentara Health; Athens (GA); On-site; USD 93,000 - 137,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Job summary

Sentara Health Plans Community Care is seeking a Utilization Review Nurse (RN) to perform utilization management tasks, including prior authorization, retrospective review, and care coordination for appropriate treatment decisions.

The role requires a current RN license and at least 3 years of acute care experience, with strong ability to apply CMS and policy criteria to authorize or deny care and support member and provider communications.

Qualifications

• Active RN license required.
• Minimum 3 years of acute care clinical experience.
• Proficiency with Microsoft Office preferred.

Responsibilities

• Conducts utilization management services including prior authorization and retrospective review.
• Ensures decisions align with CMS/state policy and medical criteria.
• Supports care coordination, referrals, and member/provider communications.

Skills

Care coordination

Prior authorization

Clinical criteria

Education

Registered Nurse (RN) license

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Sentara Health Plans Community Care is seeking a Utilization Review Nurse (RN) to perform utilization management tasks, including prior authorization, retrospective review, and care coordination for appropriate treatment decisions.

The role requires a current RN license and at least 3 years of acute care experience, with strong ability to apply CMS and policy criteria to authorize or deny care and support member and provider communications.