RN Utilization Review Nurse: Care Coordination & Compliance

Sentara Health; Carson City (NV); On-site; USD 93,000 - 137,000; Full time

Benefits offered by this job

Medical Plan

Dental Plan

Vision Plan

PTO & Sick Leave

401k Match

Tuition Assistance

Student Debt Paydown

Bonus Opportunities

Job summary

Sentara Health Plans Community Care is seeking an experienced Utilization Review Nurse (RN) to perform utilization management activities within licensure. Responsibilities include prior authorization, retrospective review, and care coordination to ensure treatment meets criteria and policy.

The role requires strong communication and problem-solving skills, a BSN preferred, RN certification, and at least 3 years acute care experience.

Qualifications

• BSN preferred.
• RN required.
• 3 years acute care clinical experience required.
• Milliman/NCQA/MS Office preferred.

Responsibilities

• Utilization management services within licensure. Includes prior authorization, retrospective review, and care coordination.
• Reviews provider requests for services requiring authorization and communicates decisions to members/providers.

Skills

Oral communication

Written communication

Interpersonal skills

Problem solving

Facilitation skills

Analytical skills

Education

BSN (preferred)

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Sentara Health Plans Community Care is seeking an experienced Utilization Review Nurse (RN) to perform utilization management activities within licensure. Responsibilities include prior authorization, retrospective review, and care coordination to ensure treatment meets criteria and policy.

The role requires strong communication and problem-solving skills, a BSN preferred, RN certification, and at least 3 years acute care experience.