Utilization Review Nurse – RN, Care Coordination

Sentara Health; New Hampshire; Presencial; USD 93.000 - 137.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, Dental, Vision

Paid time off

Discretionary bonus

Life Insurance

Legal Resources Plan

Emergency Backup Care

Descripción de la vacante

Sentara Health Plans Community Care is seeking an experienced Utilization Review Nurse (RN) to perform utilization management duties including prior authorization, pre-certification and care coordination. You will apply CMS/state criteria, medical policy and contracts to determine approvals or denials and assist in achieving accreditation standards.

Strong MS Office skills are preferred.

Formación

• Registered Nurse (required).
• 3 years of acute care clinical experience (required).
• Proficiency with Microsoft Word, Excel and Outlook preferred.

Responsabilidades

• Performs utilization management services including prior authorization, retrospective review, medical director referrals and related letters.
• Oversees pre-certification and care coordination to ensure treatment is appropriate and compliant.
• Applies criteria, medical policy, and member eligibility/contract terms to decisions.

Conocimientos

RN license

Acute care experience

Care coordination

Microsoft Word

Microsoft Excel

Microsoft Outlook

Herramientas

Microsoft Word

Microsoft Excel

Microsoft Outlook

Descripción del empleo

Sentara Health Plans Community Care is seeking an experienced Utilization Review Nurse (RN) to perform utilization management duties including prior authorization, pre-certification and care coordination. You will apply CMS/state criteria, medical policy and contracts to determine approvals or denials and assist in achieving accreditation standards.

Strong MS Office skills are preferred.