Utilization Review Nurse-Weekends-Remote

At Sentara, one of our values is to keep you safe. Sentara and many other companies across the US are being targeted by cyber criminals who are impersonating representatives of the company, claiming to have job offers. Sentara will never ask you for banking or personal identification information via email or text. We will never ask an applicant to pay money for training, supplies, or other so-called expenses. If you suspect you have received a fraudulent job offer, e-mail taadmin@sentara.com. Award-winning: Sentara is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering more than 500 sites of care including 12 hospitals, PACE (Elder Care), home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!

Sentara Health Plan is currently seeking a full-time, Utilization Review Nurse This position is Remote, Weekend Days.

RN Clinician responsible for utilization 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. Conducts 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.