RN Utilization Review Specialist: Care Coordination

Sentara Health; Saint Paul (MN); On-site; USD 93,000 - 137,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k/403b with match

Paid Time Off

Education assistance

Life and Disability insurance

Job summary

Sentara Health Plans Community Care in Norfolk, VA is seeking a Utilization Review Nurse (RN) to manage utilization management, including prior authorization, retrospective reviews, and care coordination for appropriate treatment.

The role requires an RN with 3 years of acute care experience; BSN preferred, Milliman/NCQA knowledge a plus. Base pay ranges and comprehensive benefits accompany this opportunity.

Qualifications

• RN with current licensure and BSN preferred.
• Minimum 3 years of acute care clinical experience.
• Utilization Review or prior authorization experience preferred.
• Knowledge of NCQA and Milliman preferred.
• Strong oral and written communication, facilitation and analytical skills.

Responsibilities

• Perform prior authorization, retrospective review, and care coordination.
• Assess service requests for medical necessity per criteria and policy.
• Provide timely written/verbal notification to members and providers.
• Ensure compliance with accrediting and regulatory standards.

Skills

Communication

Analytical skills

Problem solving

Interpersonal skills

Education

BSN (preferred)

Registered Nurse (RN)

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Sentara Health Plans Community Care in Norfolk, VA is seeking a Utilization Review Nurse (RN) to manage utilization management, including prior authorization, retrospective reviews, and care coordination for appropriate treatment.

The role requires an RN with 3 years of acute care experience; BSN preferred, Milliman/NCQA knowledge a plus. Base pay ranges and comprehensive benefits accompany this opportunity.