Utilization Review Registered Nurse

Sentara Hospitals; United States; Remote; USD 90,000 - 136,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k/403B with Employer Match

Paid Time Off and Sick Leave

Paid Parental & Family Caregiver Leave

Tuition Assistance

Student Debt Pay Down

Life Insurance

Job summary

Sentara Health is hiring a Remote Utilization Review Registered Nurse to perform prior authorization and utilization review for inpatient and outpatient services. Candidates must reside in Virginia and hold an active Virginia RN license.

As an integrated care manager, you will review care initiatives for appropriateness, ensure compliance with criteria and regulatory requirements, and communicate pertinent clinical information in writing or verbally.

Qualifications

• RN Diploma is required; BSN preferred.
• Virginia RN license required; certification within one year for integrated care management.
• 3 years of acute care nursing experience required.
• 3 years of case management experience preferred.
• Strong verbal and written communication and critical thinking.
• Proficient in basic computer skills.

Responsibilities

• Conduct prior authorization for inpatient and outpatient reviews.
• Perform concurrent continued stay reviews for appropriate settings.
• Ensure compliance with criteria and regulatory requirements.
• Communicate pertinent clinical information in writing or verbally.

Skills

Utilization review

Care management

Communication

Critical thinking

Education

RN Diploma

BSN (preferred)

Job description

City/State

Norfolk, VA

Work Shift

First (Days)

Overview

Sentara Health is hiring a Remote Utilization Review Registered Nurse.

Candidates must reside in the State of Virginia.

As an integrated care manager, specializing in Utilization review, the registered nurse will be responsible for utilization review services within the scope of licensure.Conducts primary function of prior authorization for inpatient and outpatient reviews both initial and concurrent continued stay review. Reviews for appropriate treatment setting to ensure compliance with applicable criteria, and regulatory requirements.Responsible for written and /or verbal communication of pertinent clinical information.

Education

• N-3 Years RN- Diploma (required)
• BSN (preferred)

Certification

• Registered Nurse in the State of Virginia (required)
• For Integrated Care Management departments, specialty certification required within one year of eligibility (ACM, CCM, CCCTM, CMAC or CGMT-BC). For other service lines, certification based on specialty area required within one year of eligibility.

Experience

• 3 years of nursing experience in acute care (required)
• 3 years Case Management experience (preferred)
• Strong verbal and written communication, critical thinking
• Proficient in basic computer skills

Keywords: Talroo- Health, Utilization Review, RN, Care Management

We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay range for full-time employment is $89,544.00 - $136,468.80 annually. Additional compensation may be available for this role, such as shift differentials, on-call pay, shift premiums, extra-shift incentives, or bonus opportunities. Compensation within the range may vary based on qualifications, experience, location, market conditions, and business needs. Note: If an annual salary is posted, it is based on a full-time colleague working 2,080 hours annually. Sentara offers a comprehensive benefits package, including medical, dental, vision, life and disability insurance; 401(k)/403(b) with employer match; paid time off (vacation, sick time, and holidays); paid parental and military leave; educational assistance or student loan repayment; and voluntary benefits.

Benefits: Caring For Your Family and Your Career

• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance - $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down - $10,000
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus ifestablished system and employee eligibility criteria is met.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission "to improve health every day," this is a tobacco‑free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.