Utilization Review RN: Care Coordination & Authorization

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

Benefits offered by this job

Adoption reimbursement up to $10,000

Emergency backup care

Disability plans

Life Insurance

Legal resources plan

Discretionary bonus

Job summary

Sentara Health Plans Community Care is seeking a Utilization Review Nurse to provide utilization management services under licensure, including prior authorization, retrospective review, and care coordination for appropriate treatment.

The role requires a Registered Nurse with at least 3 years of acute care experience; Microsoft Office proficiency is preferred. The base pay range is $93,184.00–$136,947.20 annually, with potential bonuses and comprehensive benefits.

Qualifications

• Registered Nurse (RN) required.
• 3 years of acute care clinical experience required.

Responsibilities

• Performs utilization management services including prior authorization, retrospective review, and medical director referrals.
• Executes member/provider approvals or denials.
• Performs pre-certification and care coordination for treatment appropriateness and reviews against criteria and policies.
• Ensures decisions align with CMS, state regulations, and medical policy.
• Supports accreditation through proper understanding and application of accrediting standards.

Skills

Registered Nurse (RN)

Acute care experience

Microsoft Office

Education

Nursing degree (RN)

Tools

Microsoft Office Suite

Job description

Sentara Health Plans Community Care is seeking a Utilization Review Nurse to provide utilization management services under licensure, including prior authorization, retrospective review, and care coordination for appropriate treatment.

The role requires a Registered Nurse with at least 3 years of acute care experience; Microsoft Office proficiency is preferred. The base pay range is $93,184.00–$136,947.20 annually, with potential bonuses and comprehensive benefits.