Integrated Nurse Case Manager/Registered Nurse (RN) for Inpatient and Outpatient Clinical Appeals- Remote in Virginia!

Sentara Health • Virginia Beach, VA

1d • Remote

About The Position

Sentara Health Plans is hiring an Integrated Nurse Case Manager/Registered Nurse (RN) for Inpatient and Outpatient Clinical Appeals. This is a full-time, permanent position (40 hours) with standard working hours from 8am to 5pm EST, Monday through Friday, and is remote in Virginia. The role involves managing inpatient and outpatient provider appeals across all payer types, including government and commercial insurance. Responsibilities include reviewing clinical denials (non-billing related), identifying root causes, and performing post-claim analysis to support appeal submissions. Sentara Health is an integrated, not-for-profit health care delivery system with over 135 years in operation, focused on improving health daily. It is one of the largest health systems in the U.S. Mid-Atlantic and Southeast, and among the top 20 largest not-for-profit integrated health systems in the country, with 34,000 employees, 12 hospitals, and the Sentara Health Plans division serving over 1 million members. Sentara is nationally recognized for clinical quality and safety, and for its family-friendly culture, community involvement, and opportunities for development and growth. Sentara Independence provides quality outpatient services, including an ambulance-accessible emergency room, advanced imaging, and physical therapy. Sentara Health is an equal opportunity employer committed to diversity, inclusion, and belonging, and operates as a tobacco-free environment. Sentara Health employs associates in various states for remote work.

Requirements

• RN-Diploma (Non-degree) REQUIRED
• Registered Nurse (RN) License (Compact or Virginia)
• 3 years experience in Nursing REQUIRED

Nice To Haves

• Bachelors Degree in Nursing preferred
• Experience/knowledge in Rev Cycle, Utilization Review (UR) and Case Management preferred
• Provider appeals experience is a plus
• Strong proficiency in Excel

Responsibilities

• Manage inpatient and outpatient provider appeals across all payer types, including government and commercial insurance
• Review clinical denials (non-billing related)
• Identify root causes of clinical denials
• Perform post-claim analysis to support appeal submissions

Benefits

• 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
• Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance
• Legal Resources Plan
• Colleagues may have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees