RN Utilization Review Specialist

Acentra Health; Richmond (VA); On-site; USD 39,000 - 54,000; Full time

Benefits offered by this job

Health plans

Paid time off

Retirement savings

Educational assistance

Corporate discounts

Job summary

Acentra Health is seeking a qualified RN with utilization management experience to review medical records against contract requirements. The role requires an active Virginia license and a degree in a related field. You will manage daily workflows, ensure timeliness and quality, and liaise with providers to resolve issues.

The position emphasizes collaboration, ongoing training, and adaptability in a dynamic healthcare environment. Competitive pay and comprehensive benefits accompany the role.

Qualifications

• Active unrestricted RN or Behavioral Health license in Virginia.
• Bachelor's or Master's degree in a related field.
• 1+ years' experience with Utilization Management.
• Knowledge of medical records and disease processes is preferred.
• Excellent written and verbal communication skills required.

Responsibilities

• Review medical records against contract requirements with clinical expertise.
• Ensure accuracy and timeliness of all applicable review type cases.
• Manage daily workload and queues; adjust schedules to meet workload demands.
• Participate in quality monitoring activities and maintain knowledge of review processes.
• Serve as liaison for providers and customer service issues; resolve problems.
• Perform all applicable review types as workload indicates.
• Build positive relationships with internal and external customers.
• Attend training and meetings for updated information.
• Cross-train to provide flexible workforce to meet client needs.

Skills

RN license

Utilization Management

Strong communication skills

Critical thinking

Education

Bachelor's or Master's degree in a related field

Job description

Acentra Health is seeking a qualified RN with utilization management experience to review medical records against contract requirements. The role requires an active Virginia license and a degree in a related field. You will manage daily workflows, ensure timeliness and quality, and liaise with providers to resolve issues.

The position emphasizes collaboration, ongoing training, and adaptability in a dynamic healthcare environment. Competitive pay and comprehensive benefits accompany the role.