Utilization Review RN: Care Coordination & Authorization

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

Benefits offered by this job

Medical, dental, vision plans

Paid Time Off

401k with employer match

Tuition Assistance

Student Debt Pay Down

Life Insurance

Disability plans

Annual discretionary bonus

Legal Resources Plan

Job summary

Sentara Health Plans Community Care in Norfolk, VA is looking to hire a Utilization Review Nurse to support utilization management, prior authorizations, and care coordination within licensure guidelines.

The role requires RN licensure, BSN preferred, and about 3 years of acute care experience; you will interpret criteria, notify providers and members, and contribute to accreditation and quality initiatives.

Qualifications

• RN licensure required.
• BSN preferred.
• 3 years of acute care clinical experience required.
• Utilization Review experience preferred.

Responsibilities

• Perform utilization management within licensure scope.
• Handle prior authorizations, retrospective reviews and referrals.
• Communicate determinations to members and providers.
• Ensure decisions align with CMS, state regulations and policy.
• Support accreditation through proper interpretation of standards.

Skills

Communication skills

Analytical skills

Problem-solving

Facilitation skills

Microsoft Word

Microsoft Excel

Microsoft Outlook

Education

BSN preferred

Tools

Microsoft Word

Excel

Outlook

Job description

Sentara Health Plans Community Care in Norfolk, VA is looking to hire a Utilization Review Nurse to support utilization management, prior authorizations, and care coordination within licensure guidelines.

The role requires RN licensure, BSN preferred, and about 3 years of acute care experience; you will interpret criteria, notify providers and members, and contribute to accreditation and quality initiatives.