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Professional Remote Rn Chart Review Jobs in Virginia

QTC

Registered Nurse

Mclean, VA · On-site +1

Provide support with chart reviews/documentation, scheduling and confirming appointments, answering ... C., dba QTC Medical Group of Alaska, a Leidos QTC Health Services affiliated medical professional ...

Veterans Health Administration

Nurse

Fredericksburg, VA · On-site +1

$82K - $228K/yr

Excellent organizational skills and ability to conduct clinical chart reviews, review of medical ... Graduate of a school of professional nursing approved by the appropriate accrediting agency and ...

Imh

The RN Triage and Transition is a remote position; however the caregiver must reside in Colorado or ... record review, payor models, medical risk scores, or referrals. Assesses patients' medical ...

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Professional Remote Rn Chart Review information

What is the difference between Professional Remote Rn Chart Review vs Medical Records Reviewer?

AspectProfessional Remote Rn Chart ReviewMedical Records Reviewer
CredentialsRegistered Nurse (RN) licenseVaries; often includes medical background or certification
Work EnvironmentRemote, healthcare-focusedRemote or onsite, administrative or healthcare settings
Industry UsageHealthcare, insurance, legal casesHealthcare, insurance, legal documentation
Job FocusReviewing patient charts for accuracy, compliance, and medical necessityReviewing medical records for completeness, accuracy, and compliance

The Professional Remote Rn Chart Review primarily involves licensed RNs analyzing patient charts for medical accuracy and compliance, often for insurance or legal purposes. Medical Records Reviewers may have a broader background and focus on verifying the completeness and correctness of medical documentation. While both roles are remote and healthcare-related, the RN chart review emphasizes clinical expertise, whereas medical records reviewers may not require nursing credentials.

What are the most commonly searched types of Remote Rn Chart Review jobs in Virginia? The most popular types of Remote Rn Chart Review jobs in Virginia are:
What cities in Virginia are hiring for Professional Remote Rn Chart Review jobs? Cities in Virginia with the most Professional Remote Rn Chart Review job openings:
Professional Remote Rn Chart Review jobs near you
Utilization Review Nurse/ Registered Nurse (RN) for LTSS Waiver/Medicaid - Remote in Virginia

Utilization Review Nurse/ Registered Nurse (RN) for LTSS Waiver/Medicaid - Remote in Virginia

Sentara Health

Norfolk, VA • Remote

$10K/mo

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Sentara Health rating

6.9

Company rating: 6.9 out of 10

Based on 391 frontline employees who took The Breakroom Quiz

444th of 880 rated healthcare providers

Job description

City/State
Norfolk, VA
Work Shift
First (Days)
Overview:
Sentara Health Plansis hiring an Utilization Review Nurse/RN- Remote in Virginia
Status: Full-time,permanent position (40 hours)

Standard working hours: 8am to 5pm EST, M-F

Location: Remote in Virginia
Job responsibilities:
  • 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.
  • May manage appeals for services denied.
  • Responsible for written and/or verbal notification to members and providers.
  • Demonstrates proactive anticipatory discharge planning; serves as joint transition of care coordinator with case management and facilitates member care transition.
  • 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:
  • Bachelors Degree in Nursing preferred

Certification/Licensure
  • Registered Nurse (RN) License (Compact or Virginia) REQUIRED

Preferred qualifications:
  • 3 years of acute care clinical experience REQUIRED
  • Previous Utilization Review highly preferred
  • Previous LTSS Waiver OR Medicaid experience highly preferred
  • InterQual or Milliman experience preferred.
  • Knowledge of NCQA preferred.
  • Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

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-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.
Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.
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.
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!
To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-99842
Talroo - Nursing
Utilization, Review, Registered Nurse, BSN, ADN, Nursing, Managed Care, MCO, Health Plan, Virginia, RN, VA, LTSS, Long Term Support Services, Medicaid,
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
• Reimbursement for certifications and free access to complete CEUs and professional development
•Pet Insurance
•Legal Resources Plan
•Colleagues have the opportunity to earn an annual discretionary bonus ifestablished 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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