RN Utilization Review Specialist - Care Coordination

Sentara Health; Muncie (IN); On-site; USD 93,000 - 137,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

Paid Time Off and Sick Leave

Tuition Assistance - $5,250/year

Job summary

Sentara Health Plans Community Care is seeking a Utilization Review Nurse in Norfolk, VA. This RN will conduct utilization management, prior authorization, and care coordination to ensure treatment aligns with criteria and policies.

The role requires a BSN (preferred) and 3 years of acute care experience, with Milliman/NCQA knowledge and strong communication skills. Competitive benefits and salary are offered.

Qualifications

• BSN preferred.
• RN required.
• 3 years of acute care clinical experience required.
• Milliman experience preferred.
• Knowledge of NCQA preferred.
• Microsoft Office (Word, Excel, Outlook) preferred.

Responsibilities

• Perform utilization management within licensure.
• Handle prior authorization and retrospective reviews.
• Refer to medical director and prepare approval/denial letters.

Skills

Communication

Problem-solving

Facilitation

Analytical skills

Education

BSN (preferred)

Tools

Milliman

Microsoft Office

NCQA knowledge

Job description

Sentara Health Plans Community Care is seeking a Utilization Review Nurse in Norfolk, VA. This RN will conduct utilization management, prior authorization, and care coordination to ensure treatment aligns with criteria and policies.

The role requires a BSN (preferred) and 3 years of acute care experience, with Milliman/NCQA knowledge and strong communication skills. Competitive benefits and salary are offered.