Utilization Review RN – Care Coordination

Sentara Health; South Carolina; On-site; USD 93,000 - 137,000; Full time

Benefits offered by this job

Adoption reimbursement

Emergency backup care

Disability insurance

Life insurance

Legal resources plan

Discretionary bonus

Job summary

Sentara Health Plans Community Care is seeking a Utilization Review Nurse. The RN will perform utilization management, including prior authorizations, pre-certifications, and care coordination to ensure appropriate treatment and adherence to policies.

The role requires 3 years of acute care experience and active RN licensure. The position offers a comprehensive benefits package and potential discretionary bonuses, with base pay ranging from $93,184 to $136,947 annually for full-time work, plus

Qualifications

• Registered Nurse license required.
• 3 years of acute care clinical experience required.

Responsibilities

• Conducts utilization management services including prior authorization, retrospective review, and medical director referrals.
• Executes member/provider approval or denial letters.
• Performs pre-certification and care coordination for treatment appropriateness and reviews against criteria and policy.
• Ensures decisions align with CMS, state, medical policy, and clinical criteria.

Skills

RN

Acute care experience

Care coordination

Education

Registered Nurse license

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Sentara Health Plans Community Care is seeking a Utilization Review Nurse. The RN will perform utilization management, including prior authorizations, pre-certifications, and care coordination to ensure appropriate treatment and adherence to policies.

The role requires 3 years of acute care experience and active RN licensure. The position offers a comprehensive benefits package and potential discretionary bonuses, with base pay ranging from $93,184 to $136,947 annually for full-time work, plus