RN Utilization Review Specialist | Care Coordination

Sentara Health; Kansas; On-site; USD 93,000 - 137,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Paid time off

Bonus opportunities

Job summary

Sentara Health Plans Community Care is seeking a Utilization Review Nurse to provide utilization management services, including prior authorizations and care coordination within licensure. The role emphasizes applying accrediting and regulatory standards, with potential for additional compensation and comprehensive benefits.

The candidate must be a registered nurse with at least 3 years of acute care experience. Knowledge of Milliman/NCQA and Microsoft Office is preferred.

Qualifications

• RN licensed to practice in the state
• Experience in utilization management or case management is preferred
• Proficiency with Microsoft Office and data documentation

Responsibilities

• Perform prior authorizations and retrospective reviews
• Coordinate care and pre-certifications to ensure treatment appropriateness
• Apply CMS/state criteria and medical policy accurately

Skills

Utilization review

Care coordination

Acute care experience

RN license

Education

Licensed RN (RN)

Tools

Milliman

NCQA

Microsoft Office

Job description

Sentara Health Plans Community Care is seeking a Utilization Review Nurse to provide utilization management services, including prior authorizations and care coordination within licensure. The role emphasizes applying accrediting and regulatory standards, with potential for additional compensation and comprehensive benefits.

The candidate must be a registered nurse with at least 3 years of acute care experience. Knowledge of Milliman/NCQA and Microsoft Office is preferred.