Utilization Review Registered Nurse

101 Sentara Hospitals; Virginia; Hybrid; USD 90,000 - 136,000; Full time

Benefits offered by this job

Medical benefits

Dental & Vision

PTO & Sick Leave

Parental leave

Disability insurance

Life Insurance

401k match

Tuition assistance

Student debt pay down

Pet insurance

Legal resources plan

Annual bonus eligibility

Job summary

Sentara Health is seeking a Remote Utilization Review Registered Nurse based in Virginia. The role focuses on utilization review and prior authorization for inpatient and outpatient cases, with emphasis on upholding regulatory criteria and documenting clinical information.

The ideal candidate has a Virginia RN license, 3+ years of acute care nursing, and 3 years in case management, with strong verbal and written communication skills and computer proficiency.

Qualifications

• RN licensed in Virginia; notable clinical experience preferred.
• Minimum 3 years nursing experience in acute care.
• 3 years case management experience preferred.

Responsibilities

• Perform prior authorization for inpatient and outpatient reviews (initial and concurrent).
• Assess utilization to determine appropriate treatment setting and regulatory compliance.
• Communicate relevant clinical information in written and/or verbal form.

Skills

Utilization review

Registered Nurse (RN)

Case management

Verbal communication

Written communication

Critical thinking

Computer skills

Education

RN Diploma

BSN

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.

Benefits:

• 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 if established 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. Sentara Health is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering hundreds of sites of care including 12 hospitals, PACE, home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!