Commercial Utilization Review Nurse/RN - Remote in VA

About the Role

100% remote. M-F 8-5 EST. No weekends. No nights. Full-time RN role. Work from your couch. Done.

Work-Life Balance Factors

No night shifts No weekend work Remote/telehealth

Key Responsibilities

• RN Clinician responsible for utilization management services within the scope of licensure.
• Reviews provider requests for services requiring authorization.
• Conducts pre
• May manage appeals for services denied.
• Responsible for written and/or verbal notification to members and providers.
• Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.

Requirements

• Bachelor's Level Degree in Nursing preferred
• Certification/License:
• Registered Nurse License (RN)
• Nursing License
• State License
• Experience:

Benefits & Compensation

• Sentara Health is currently hiring for a Utilization Review Nurse
• Commercial Health Insurance experience preferred
• Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee
• sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.
• We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health.
• Utilization Review Nurse, RN, BSN, InterQual, Milliman, NCQA, Remote, Virginia, Case Management, BSN, Bachelor's, Commercial, Health Plan, Health Insurance, Managed Care, MCO

Work Schedule

• time, permanent position (40 hours)
• Standard working hours: 8am to 5pm EST, M