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Live In Cigna Utilization Review Nurse Jobs in Virginia

The Utilization Review Nurse is responsible for utilization management services within the scope of ... In support of our mission "to improve health every day," this is a tobacco-free environment. For ...

... Assist in preparing Utilization Review Reports as necessary. • Coordinates and makes ... Nursing) A minimum of three (3) years direct clinical experience in a psychiatric or mental health ...

... Nursing) A minimum of three (3) years direct clinical experience in a psychiatric or mental health ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...

... Nursing) A minimum of three (3) years direct clinical experience in a psychiatric or mental health ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...

... Nursing) A minimum of three (3) years direct clinical experience in a psychiatric or mental health ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...

... Nursing) A minimum of three (3) years direct clinical experience in a psychiatric or mental health ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...

The Utilization Review Coordinator assists admissions in screening patients at the pre-hospital level to ensure that admission criteria are met, and when admitted, follows the chart checking that ...

... nursing staff regarding charting deficiencies and problems/issues identified. Follows up in each ... Identifies potential review problems and discuss them with multi-disciplinary team and/or ...

... nursing staff regarding charting deficiencies and problems/issues identified. Follows up in each ... Identifies potential review problems and discuss them with multi-disciplinary team and/or ...

Live in Caregiver

Manassas, VA · On-site

$200 - $240/day

Assisting Hands Home Care is seeking experienced, certified caregivers (PCA, HHA, CNA) for respite live-in assignments that could last from 1 to 3 weeks . These temporary roles support families when ...

... nursing staff regarding charting deficiencies and problems/issues identified. Follows up in each ... Identifies potential review problems and discuss them with multi-disciplinary team and/or ...

Live in Caregiver

Manassas, VA · On-site

$200 - $240/day

Wellness resources Temporary live-in assignments with meaningful impact Assisting Hands Home Care is seeking experienced, certified caregivers (PCA, HHA, CNA) for respite live-in assignments that ...

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Live In Cigna Utilization Review Nurse information

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UTILIZATION REVIEW NURSE

Sentara Healthcare

Norfolk, VA • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 8 days ago


Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 416 frontline employees who took The Breakroom Quiz

498th of 898 rated healthcare providers


Job description

City/State
Norfolk, VA
Work Shift
First (Days)
Overview:
Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse.
The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, 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, care coordination for appropriateness of treatment, set reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Responsible for written and/or verbal notification to members and providers. Ensures medical director written decision is consistent with criteria (CMS, state, medical policy, clinical criteria). Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
Education:
• BSN (preferred)
Certification:
• Registered Nurse (required)
Experience:
• 3 years of acute care clinical experience (required)
• Previous Utilization Review experience (preferred)
• Milliman experience (preferred)
• Knowledge of NCQA (preferred)
• Microsoft suite (Word, Excel, Outlook) (preferred)
• Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
Keywords: Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQA
Benefits: Caring For Your Family and Your Career
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
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and 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.
In support of our mission "to improve health every day," this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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