Utilization Review Registered Nurse

Sentara Hospitals; Virginia Beach (VA); Remote; USD 90,000 - 136,000; Full time

Benefits offered by this job

Medical Insurance

401(k) Match

Paid Time Off

Educational Assistance

Student Debt Paydown

Discretionary Bonus

Job summary

Sentara Health is hiring a Remote Utilization Review Registered Nurse based in Virginia. The role focuses on prior authorization for inpatient and outpatient reviews, ensuring appropriate treatment settings and compliance with regulatory criteria.

Licensing must be valid in Virginia, with strong verbal and written communication skills. The ideal candidate has a VA RN diploma (BSN preferred), at least 3 years in acute care and 3 years in case management, and proficiency with basic computer

Qualifications

• RN diploma required for licensure in Virginia.
• BSN preferred but not required.
• Minimum 3 years of nursing in acute care.
• 3 years of case management experience preferred.
• Strong verbal and written communication; basic computer skills.

Responsibilities

• Conduct utilization review within licensure scope.
• Perform prior authorization for inpatient and outpatient reviews.
• Assess treatment settings for compliance with criteria and regulations.
• Communicate pertinent clinical information verbally and in writing.

Skills

RN license

Case Management

Verbal communication

Written communication

Critical thinking

Basic 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.

Job Description

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

Compensation

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 – Comprehensive Packages

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 if established system and employee eligibility criteria is met.

Equal Opportunity and Diversity

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.

Workplace Environment

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

Remote Work Availability

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.