RN Utilization Review: Prior Authorization & Coordination

Sentara Health; Crystal Bay (NV); In loco; USD 93.000 - 137.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical/Dental/Vision

PTO & Sick Leave

Parental Leave

Emergency Backup Care

Disability Plans

Life Insurance

401k Match

Tuition Assistance

Student Debt Paydown

Pet Insurance

Legal Resources

Annual Bonus

Descrizione del lavoro

Sentara Health Plans Community Care invites applications for an Utilization Review Nurse. You will perform prior authorization, retrospective reviews and care coordination within licensure, ensuring compliance with medical policies and contracts. Excellent communication and analytical skills are essential.

The role requires a BSN preferred and RN licensure, with at least 3 years acute care experience; Milliman/NCQA familiarity is a plus, and you will contribute to accreditation readiness.

Competenze

• BSN preferred and RN license required.
• 3 years of acute care clinical experience.
• Utilization Review experience and familiarity with Milliman/NCQA are valued.

Mansioni

• Perform prior authorization, prospective and retrospective reviews.
• Coordinate care and approve/deny requests per policy and contract terms.
• Communicate decisions to members and providers in writing or verbally.

Conoscenze

Communication

Analytical

Interpersonal skills

Formazione

BSN (preferred)

RN license

Strumenti

Milliman

NCQA

MS Office

Descrizione del lavoro

Sentara Health Plans Community Care invites applications for an Utilization Review Nurse. You will perform prior authorization, retrospective reviews and care coordination within licensure, ensuring compliance with medical policies and contracts. Excellent communication and analytical skills are essential.

The role requires a BSN preferred and RN licensure, with at least 3 years acute care experience; Milliman/NCQA familiarity is a plus, and you will contribute to accreditation readiness.