Utilization Review Nurse
1 month ago
As a Utilization Review Nurse with Sentara Healthcare, you will be responsible for providing comprehensive care coordination services and quality outcomes for patients across the continuum. Your primary duty will be to customize what is best for the patients, including helping with things like home health, long-term care placement, home medical equipment, and homeless and community resources. You will work in an intensely collaborative way with the patients, family, and members of the medical team to provide patients with the resources they need and help prevent them from readmitting to the hospital.
Responsibilities:
Conducts primary function of prior authorization for inpatient and outpatient reviews both initial and concurrent continued stay review.
Reviews for appropriateness of treatment setting to ensure compliance with applicable criteria, and regulatory requirements.
Responsible for written and/or verbal communication of pertinent clinical information.
Qualifications:
Required Minimum of 3 years of nursing, acute care experience.
Valid RN License.
Skills:
Required - Verbal and Written Communication, Critical Thinking, Proficiency with basic computer skills.
Benefits:
Sentara offers an attractive array of full-time benefits including Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B, 401a, Performance Plus Bonus, Career Advancement Opportunities, Work Perks, and more.
About Sentara Healthcare:
Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
This is a tobacco-free environment.
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