Utilization Review Registered Nurse
About The Position
Sentara Health is hiring a remote Utilization Review Registered Nurse. Candidates must reside in Virginia. As an integrated care manager specializing in utilization review, the registered nurse provides utilization review services within the scope of licensure. The primary function is conducting prior authorization for inpatient and outpatient reviews, including initial and concurrent continued-stay reviews. The nurse reviews the appropriateness of treatment settings to ensure compliance with applicable criteria and regulatory requirements, and communicates pertinent clinical information in writing and/or verbally.
Requirements
- Registered Nurse in the State of Virginia.
- Three years of nursing experience in acute care.
- Strong verbal and written communication skills.
- Critical-thinking skills.
- Proficiency in basic computer skills.
Nice To Haves
- Bachelor of Science in Nursing (BSN).
- Three years of case management experience.
- For Integrated Care Management departments, specialty certification is required within one year of eligibility: ACM, CCM, CCCTM, CMAC, or CGMT-BC. For other service lines, certification based on the specialty area is required within one year of eligibility.
Responsibilities
- Conduct prior authorization for inpatient and outpatient reviews, including initial and concurrent continued-stay reviews.
- Review the appropriateness of treatment settings to ensure compliance with applicable criteria and regulatory requirements.
- Communicate pertinent clinical information in writing and/or verbally.
- Provide utilization review services within the scope of licensure.
Benefits
- Medical, dental, and vision plans
- Life and disability insurance, including long-term and short-term disability and critical illness plans
- 401(k)/403(b) with employer match
- Paid time off, sick leave, and holidays
- Paid parental and family caregiver leave
- Paid military leave
- Adoption, fertility, and surrogacy reimbursement up to $10,000
- Emergency backup care
- Educational assistance or student loan repayment
- Tuition assistance up to $5,250 per year and discounted educational opportunities through Guild Education
- Student debt pay down up to $10,000
- Pet insurance
- Legal resources plan
- Opportunity to earn an annual discretionary bonus, subject to established system and employee eligibility criteria
- Additional compensation may be available, including shift differentials, on-call pay, shift premiums, extra-shift incentives, or bonus opportunities.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
