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

Sentara Hospitals • Virginia Beach, VA

1d • Remote

About The Position

Sentara Health Plans is seeking an Integrated Nurse Case Manager/Registered Nurse (RN) for Inpatient and Outpatient Clinical Appeals. This is a full-time, permanent remote position (40 hours) with standard working hours from 8am to 5pm EST, Monday through Friday, for candidates located in Virginia. Sentara Health is an integrated, not-for-profit health care delivery system with over 135 years of service, committed to improving health every day. It is one of the largest health systems in the U.S. Mid-Atlantic and Southeast, ranking among the top 20 largest not-for-profit integrated health systems nationally. Sentara Health employs 34,000 individuals across 12 hospitals in Virginia and Northeastern North Carolina, including 10 Magnet® recognized hospitals, and its Sentara Health Plans division serves over 1 million members in Virginia and Florida. The organization is nationally recognized for clinical quality and safety, focusing on innovation and creating an extraordinary healthcare experience. Sentara has received accolades such as Health Quality Innovator of the Year (2024), Forbes' "America’s Best-In-State Employer” (2024), "Best Employer for Veterans" (2022, 2023), "Best Employer for Women" (2020), and IBM Watson Health's "Top 15 Health Systems" (2021, 2018). Sentara fosters a family-friendly culture, encourages community involvement, and offers opportunities for development and growth, emphasizing People, Quality, Patient Safety, Service, and Integrity. Sentara Health is an equal opportunity employer, valuing diversity, inclusion, and belonging, and operates as a tobacco-free environment. Remote positions are available for associates in various states including Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

Requirements

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

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, and 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