RN Utilization Review & Care Coordination Specialist

Sentara Health; Clayton (NC); On-site; USD 93,000 - 137,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

Paid time off

Discretionary bonus potential

Life and disability insurance

Job summary

Sentara Health Plans Community Care is seeking a Utilization Review Nurse in North Carolina. The role focuses on utilization management, prior authorization, and coordination of care to ensure appropriate treatment per policy and criteria.

The ideal candidate is a Registered Nurse with at least three years of acute care experience and familiarity with MS Word/Excel. Sentara offers comprehensive benefits and opportunities for discretionary bonus based on eligibility.

Qualifications

• Registered Nurse (RN) licensure is required.
• At least 3 years of acute care clinical experience.
• Microsoft Word, Excel, Outlook experience preferred.

Responsibilities

• Perform utilization management, including prior authorization and pre-certification.
• Coordinate care and support approvals/denials with providers and members.
• Ensure decisions align with CMS/state requirements, medical policy, and clinical criteria.
• Support medical director referrals and accurate documentation.

Skills

RN

Acute care

Care coordination

MS Word/Excel

Education

RN licensure

Tools

Milliman

Job description

Sentara Health Plans Community Care is seeking a Utilization Review Nurse in North Carolina. The role focuses on utilization management, prior authorization, and coordination of care to ensure appropriate treatment per policy and criteria.

The ideal candidate is a Registered Nurse with at least three years of acute care experience and familiarity with MS Word/Excel. Sentara offers comprehensive benefits and opportunities for discretionary bonus based on eligibility.