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Remote-Behavioral Health Utilization Review Nurse (RN) Relocation Bonus Available job in Norfolk at Sentara Health

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Remote-Behavioral Health Utilization Review Nurse (RN) Relocation Bonus Available at Sentara Health

Remote-Behavioral Health Utilization Review Nurse (RN) Relocation Bonus Available

Sentara Health Norfolk, VA (Remote) Full-Time
Job Description

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.

Job Posting

Optima Health is hiring a Remote Behavioral Health Utilization Review Nurse (RN) for the Government Hospital Review Team

Behavioral Health Utilization Review Nurse is 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). Behavioral Health Utilization Review Nurse facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.

Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For more information about our employee benefits, [ Link removed ] - Click here to apply to Remote-Behavioral Health Utilization Review Nurse (RN) Relocation Bonus Available />
Join our team, where we are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, growth!

Required Education

Bachelor's Level Degree - Experience in lieu of education: Yes

Experience

Required: Acute Care - 3 years

Preferred: Accreditation and Regulatory - Previous experience, Utilization Management - Previous experience

Licenses and Certifications

Required: Registered Nurse

Preferred: None, unless noted in the "Other" section below

Skills

Required:

Preferred: None, unless noted in the "Other" section below

Recommended Skills

  • Behavioral Medicine
  • Care Coordination
  • Case Management
  • Certified Nurse Practitioner
  • Clinical Works
  • Content Management
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