RN Utilization Review Specialist

Sentara Health; Alabama; Presencial; USD 93.000 - 137.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical benefits

Paid time off

Discretionary bonus

Descripción de la vacante

Sentara Health Plans Community Care seeks a Utilization Review Nurse. The role focuses on utilization management, including prior authorization, retrospective review, and care coordination to ensure appropriate treatment and member eligibility. RN licensure and at least 3 years of acute care experience are required.

The position offers full-time hours with competitive benefits and potential for bonuses. Base pay ranges from $93,184 to $136,947 annually, with additional compensation possible;

Formación

• RN license required.
• 3 years of acute care clinical experience required.

Responsabilidades

• Conduct utilization management including prior authorization and retrospective review.
• Coordinate care, including pre-certification and use of criteria/policies.
• Prepare and issue approval/denial letters consistent with CMS/state regulations.

Conocimientos

RN

Care Coordination

Prior authorization

Educación

Registered Nurse license

Herramientas

Microsoft Word

Microsoft Excel

Microsoft Outlook

Descripción del empleo

Sentara Health Plans Community Care seeks a Utilization Review Nurse. The role focuses on utilization management, including prior authorization, retrospective review, and care coordination to ensure appropriate treatment and member eligibility. RN licensure and at least 3 years of acute care experience are required.

The position offers full-time hours with competitive benefits and potential for bonuses. Base pay ranges from $93,184 to $136,947 annually, with additional compensation possible;