Sentara Health

Utilization Review RN Case Management. For Integrated Care Management departments, specialty certification is required within one year of eligibility (ACM, CCM, CCCTM, CMAC, or CGMT-BC).. As a Utilization Review Nurse/Integrated Care Manager RN with Sentara, you work together intensely with the patients, families, and members of the medical team to provide patients with the resources they need and help prevent them from being readmitted to the hospital.. Click to hear Meredith tell us about a day in the life of a Utilization Review RN/Integrated Care Manager with Sentara Health.. As a Utilization Review Nurse specializing in Utilization review, the registered nurse will be responsible for utilization review services within the scope of licensure.

utilization review

City/State Norfolk, VA Overview Work Shift Weekend Days (United States of America) Sentara Health is hiring a Full-Time Weekend Only Day shift Utilization Review RN Case Management for the Revenue Cycle Center in Norfolk, VA. **Premium Pay** All weekend team members for our department will work 8 hours on Fridays and Mondays and 12 hours (7-7:30) on Saturdays and Sundays. The shift times on Mon/Fri are flexible as long as they are between the hours of 6:30a-5:30p. The position is located in Norfolk, VA and currently offering a hybrid opportunity. Work from home is available every Friday and every other Sunday. Onsite work is required every Saturday, Monday, and every other Sunday. Minimum Job Requirements: <ul><li>3 years of acute care RN experience.</li><li>Valid RN license</li><li>Care Management Experience preferred.</li><li>BLS required within 90 days of hire and maintained after that (if in a clinical setting)</li><li>For Integrated Care Management departments, specialty certification is required within one year of eligibility (ACM, CCM, CCCTM, CMAC, or CGMT-BC). For other service lines, certification based on specialty area is required within one year of eligibility. </li></ul>As a Utilization Review Nurse/Integrated Care Manager RN with Sentara, you work together intensely with the patients, families, and members of the medical team to provide patients with the resources they need and help prevent them from being readmitted to the hospital. This position's primary duty is customizing what is best for the patients. That would include helping with things like home health, long-term care placement, home medical equipment, and homeless and community resources. You will find that teamwork is exceptional, with everyone working together to ensure the best care for our patients. Click https://youtu.be/3BE5pC5IfYo to hear Meredith tell us about a day in the life of a Utilization Review RN/Integrated Care Manager with Sentara Health. <ul><li>As a Utilization Review Nurse specializing in Utilization review, the registered nurse will be responsible for utilization review services within the scope of licensure. </li><li>Conducts primary function of prior authorization for inpatient and outpatient reviews both initial and concurrent continued stay review.</li><li>Reviews for appropriateness of treatment setting to ensure compliance with applicable criteria, and regulatory requirements. </li><li>Responsible for written and /or verbal communication of pertinent clinical information. </li></ul>Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth. Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve! 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. Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth. Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve! keywords: Indeed, LinkedIn, Nursing Acute Care, Full Time, Case Management, RN, Registered Nurse, BSN, ASN, utilization review, patient accounts, revenue cycle, Talroo-Nursing, Monster, care coordinator, utilization review, authorization, medical director, compliance, regulation, medical necessity, hybrid, service lines, ACM, CCM, TCM, CMAC or CGMT-BC Job Summary As an integrated care manager, specializing in Utilization review, the registered nurse will be responsible for utilization review services within the scope of licensure. 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: Minimum Of 3 Years Acute Care Experience Skills: Required – Verbal and Written Communication, Critical Thinking, Proficiency with basic computer skills Qualifications: N-2YR - RN-Associate's Degree, N-3YR - RN-Diploma (Non-degree), N-4YR - RN-Bachelor's Level Degree, N-6YR - RN-Master's Level Degree Registered Nurse (RN) Single State - Nursing License - North Carolina, Registered Nurse (RN) Single State - Nursing License - Virginia Department of Health Professionals (VADHP), Registered Nurse License (RN) - Nursing License - Compact/Multi-State License Nursing Skills Communication, Critical Thinking, Microsoft Office, Service Orientation 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. Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application. In support of our mission “to improve health every day,” this is a tobacco-free environment.

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