Utilization Review Nurse, RN – Imaging, Commercial

Job not on LinkedIn

🕒 August 25

🏈 Alabama, Florida, +24 more states – Remote

🏈 Alabama – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌪️ Kansas – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🦀 Maryland – Remote ❄️ Minnesota – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $66.8k - $111.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 34%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Sentara Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1890

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Sentara Health is a leading healthcare system that operates over 300 sites of care in Virginia and northeastern North Carolina, including 12 acute care hospitals. The company is dedicated to providing exceptional patient care, fostering professional development, and maintaining a diverse workforce. Sentara Health aims to improve health every day and has been recognized for its clinical and operational performance, being named one of the top 15 health systems by IBM Watson Health. The organization supports its employees in achieving their full potential and encourages growth and innovation in the healthcare sector.

📋 Description

• Conduct prior authorization, inpatient review, concurrent review, retrospective review, medical director referrals, and member/provider approval or denial letter execution • Review provider requests for services requiring authorization • Conduct pre-certification, continued stay review, care coordination, and discharge planning for treatment-setting appropriateness • Ensure compliance with applicable criteria, medical policy, member eligibility, benefits, and contracts • Manage appeals for denied services • Provide written and verbal notifications to members and providers • Conduct proactive anticipatory discharge planning • Serve as joint transition-of-care coordinator with case management and facilitate member care transitions • Ensure medical director decisions are consistent with CMS, state, medical policy, and clinical criteria • Apply accrediting and regulatory requirements and standards accurately • Utilize management services within the scope of licensure

🎯 Requirements

• Registered Nurse (RN) license (Compact or Virginia) REQUIRED • 3 years of acute care clinical experience REQUIRED • Bachelor's Degree in Nursing preferred • Previous utilization review experience highly preferred • Previous imaging experience preferred • InterQual or Milliman experience preferred • Knowledge of NCQA preferred • Availability to work 8am to 5pm EST, Monday through Friday • Weekend and holiday coverage required, including 13 weekend day shifts per year and assigned holiday coverage • Ability to work in one of the eligible remote 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, West Virginia, Wisconsin, or Wyoming

🏖️ Benefits

• Medical, dental, and vision plans • Adoption, fertility, and surrogacy reimbursement up to $10,000 • Paid time off and sick leave • Paid parental and family caregiver leave • Emergency backup care • Long-term disability, short-term disability, and critical illness plans • Life insurance • 401(k)/403(b) with employer match • Tuition assistance up to $5,250/year and discounted educational opportunities through Guild Education • Student debt pay down up to $10,000 • Pet insurance • Legal resources plan • Annual discretionary bonus opportunity subject to system and employee eligibility criteria • Shift differentials, standby/on-call pay, overtime, premiums, extra-shift incentives, or bonus opportunities may be available • Family-friendly culture • Opportunities for development and growth • Tobacco-free environment

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