Utilization Review Nurse (RN) – Care Coordination

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

Benefits offered by this job

Adoption & Fertility Reimbursement

Emergency Backup Care

Long-Term Disability & Short-Term Dis.

Life Insurance

Legal Resources Plan

Annual discretionary bonus

Job summary

Sentara Health Plans Community Care is seeking an Utilization Review Nurse to manage utilization management, including pre-certification, prior authorization, and care coordination, within licensure. The role ensures decisions align with CMS/state policies and accrediting standards.

Requires RN licensure and at least 3 years of acute care experience; familiarity with Microsoft Word/Excel/Outlook is preferred.

Qualifications

• RN license required.
• Minimum 3 years of acute care clinical experience.
• Microsoft Office proficiency preferred.

Responsibilities

• Perform utilization management services including prior authorization, retrospective review, and medical director referrals.
• Coordinate care and pre-certification to ensure treatment appropriateness.
• Apply criteria, policies, and contracts to decisions and communicate with members/providers.

Skills

RN licensure

Acute care experience

Microsoft Word/Excel/Outlook

Education

Registered Nurse license

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Sentara Health Plans Community Care is seeking an Utilization Review Nurse to manage utilization management, including pre-certification, prior authorization, and care coordination, within licensure. The role ensures decisions align with CMS/state policies and accrediting standards.

Requires RN licensure and at least 3 years of acute care experience; familiarity with Microsoft Word/Excel/Outlook is preferred.