RN Utilization Review & Care Coordination - Remote Options

Sentara Health; Minneota (MN); In loco; USD 93.000 - 137.000; Tempo pieno

Vantaggi offerti da questo lavoro

Adoption, Fertility and Surrogacy Reim

Emergency Backup Care

Disability plans

Life Insurance

Legal Resources Plan

Annual discretionary bonus

Descrizione del lavoro

Sentara Health Plans Community Care is hiring a Utilization Review Nurse to perform utilization management, including prior authorization, pre-certification, and care coordination for treatment appropriateness. You will apply criteria and policies and support medical director referrals and approvals or denials.

Requirements: Registered Nurse (RN) license and at least 3 years of acute care clinical experience. Proficiency with Microsoft Word, Excel, and Outlook is preferred.

Competenze

• Registered Nurse (required)
• 3 years of acute care clinical experience (required)
• Microsoft Word, Excel, Outlook proficiency preferred

Mansioni

• Perform utilization management services including prior authorization and pre-certification.
• Conduct retrospective reviews and medical director referrals.
• Approve/deny letters and ensure member eligibility, benefits, and contracts align with criteria.

Conoscenze

Care coordination

Discharge planning

Case management

Communication skills

Formazione

Registered Nurse (RN) license

Strumenti

Microsoft Word

Microsoft Excel

Microsoft Outlook

Descrizione del lavoro

Sentara Health Plans Community Care is hiring a Utilization Review Nurse to perform utilization management, including prior authorization, pre-certification, and care coordination for treatment appropriateness. You will apply criteria and policies and support medical director referrals and approvals or denials.

Requirements: Registered Nurse (RN) license and at least 3 years of acute care clinical experience. Proficiency with Microsoft Word, Excel, and Outlook is preferred.