Utilization Review Nurse/ RN for Imaging/Commercial- Remote!

City/State

Norfolk, VAWork Shift

First (Days)Overview:

Sentara Health Plans is hiring a Utilization Review Nurse/ RN for Imaging/Commercial- Remote!

Status: Full-time, permanent position (40 hours)

Standard working hours: 8am to 5pm EST, M-F. Weekend and holiday coverage required. Nurses participate in a self-scheduling process and are expected to work 13 weekend day shifts per year, as well as assigned holiday coverage.

Remote opportunities available in the following states: Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington (state), West Virginia, Wisconsin, Wyoming

Job responsibilities:

• Utilization Review Nurse is responsible for utilizing management services within the scope of licensure.

• Conducts primary functions of prior authorization, inpatient review, concurrent review, retrospective review, medical director referrals and execution of member/provider approval and/or denial letter.

• Reviews provider requests for services requiring authorization. Conduct pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.

• May manage appeals for services denied. Responsible for written and/or verbal notification to members and providers.

• Demonstrates proactive…