Utilization Review Nurse, RN – Imaging

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🔥 0 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $66.8k - $111.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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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 primary functions of prior authorization, inpatient review, concurrent review, retrospective review, medical director referrals, and member/provider approval or denial letters • Review provider requests for services requiring authorization • Conduct pre-certification, continued stay review, care coordination, and discharge planning • Ensure treatment setting reviews comply with applicable criteria, medical policy, member eligibility, benefits, and contracts • Manage appeals for denied services • Provide written and verbal notifications to members and providers • Demonstrate proactive anticipatory discharge planning • Serve as joint transition-of-care coordinator with case management and facilitate member care transitions • Ensure medical director written 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 • Ability to work 8am to 5pm EST, Monday through Friday • Weekend and holiday coverage required • Expected to work 13 weekend day shifts per year and assigned holiday coverage • Utilization review knowledge within scope of licensure

🏖️ 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 • Pet Insurance • Legal Resources Plan • Annual discretionary bonus opportunity subject to established system and employee eligibility criteria • Shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities may be available • Family-friendly culture • Opportunities for development and growth • Tobacco-free environment