RN Utilization Review & Care Coordination Specialist

Sentara Health; Bastrop (LA); On-site; USD 93,000 - 137,000; Full time

Benefits offered by this job

Medical Insurance

401k with Employer Match

Paid Time Off

Job summary

Sentara Health Plans Community Care is hiring a Utilization Review Nurse in Norfolk, VA. The RN will conduct utilization management, including prior authorization, retrospective review, and care coordination to ensure appropriate treatment and alignment with medical policy and contracts.

Requirements include RN with 3 years acute care experience; BSN preferred; Milliman/NCQA experience and strong communication and analytical skills are preferred. Competitive base pay with comprehensive benefits.

Qualifications

• Utilization management duties within licensure.
• Strong communication and problem-solving skills required.
• Proficient with clinical criteria and medical policy.

Responsibilities

• Perform prior authorization and prospective/retrospective reviews.
• Coordinate care and coordinate with medical directors for approvals/denials.
• Ensure compliance with CMS, state, and accrediting standards.

Skills

Utilization Review

Care Coordination

Prior Authorization

Analytical Skills

Education

BSN (preferred)

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Sentara Health Plans Community Care is hiring a Utilization Review Nurse in Norfolk, VA. The RN will conduct utilization management, including prior authorization, retrospective review, and care coordination to ensure appropriate treatment and alignment with medical policy and contracts.

Requirements include RN with 3 years acute care experience; BSN preferred; Milliman/NCQA experience and strong communication and analytical skills are preferred. Competitive base pay with comprehensive benefits.