Utilization Review RN: Care Coordination & Approvals

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

Benefits offered by this job

Adoption, Fertility and Surrogacy Reim

Emergency Backup Care

Long-Term Disability

Short-Term Disability

Critical Illness plans

Life Insurance

Legal Resources Plan

Annual discretionary bonus

Job summary

Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse. The RN will perform utilization management services, including prior authorization, retrospective review, and care coordination to determine appropriateness of treatment and ensure compliance with policy.

The position requires an active RN license and at least 3 years of acute care experience. It is a full-time role with competitive benefits and opportunities for additional compensation based on performance.

Qualifications

• RN licensure required and eligible to practice.
• Minimum 3 years acute care clinical experience.
• Proficient with Microsoft Office applications preferred.

Responsibilities

• Perform prior authorization and retrospective reviews per policy.
• Coordinate care and appropriate treatment with medical staff.
• Prepare and communicate approvals/denials in line with medical policy.
• Ensure decisions align with CMS/state regulations and medical criteria.

Education

Registered Nurse (RN) license

Tools

Microsoft Office

Job description

Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse. The RN will perform utilization management services, including prior authorization, retrospective review, and care coordination to determine appropriateness of treatment and ensure compliance with policy.

The position requires an active RN license and at least 3 years of acute care experience. It is a full-time role with competitive benefits and opportunities for additional compensation based on performance.