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 evaluates the appropriate treatment setting for 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.
- At least 3 years of nursing experience in acute care.
- Strong verbal and written communication skills.
- Critical-thinking skills.
- Proficiency in basic computer skills.
- For Integrated Care Management departments, obtain a specialty certification within one year of eligibility (ACM, CCM, CCCTM, CMAC, or CGMT-BC). For other service lines, obtain certification based on the specialty area within one year of eligibility.
- Nursing diploma (listed as N-3 Years RN-Diploma required).
Nice To Haves
- Bachelor of Science in Nursing (BSN).
- 3 years of case management experience.
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.
- Adoption, fertility, and surrogacy reimbursement up to $10,000.
- Paid time off and sick leave, including vacation and holidays.
- Paid parental and family caregiver leave.
- Emergency backup care.
- Long-term and short-term disability and critical illness plans.
- Life insurance.
- 401(k)/403(b) with employer match.
- 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 include shift differentials, on-call pay, shift premiums, extra-shift incentives, or bonus opportunities.
- Paid military leave.
- Educational assistance or student loan repayment.
- Voluntary benefits.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
