Remote RN Utilization Review/Case Management – Norfolk, VA

Full time
Posted Today
JR-39222

City/State

Norfolk, VA

Overview

Work Shift

Weekend Days (United States of America)

Sentara Healthcare is hiring a Full-Time Weekend Only Day shift

**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 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.

Utilization Review Nurse Case Management 

for the Revenue Cycle Center in Norfolk, VA.

As a Utilization Review Nurse with Sentara, you get to work together 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 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 Healthcare.

• As a Utilization Review Nurse 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:

*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

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!

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Job Summary

Responsible and accountable for the provision and facilitation of comprehensive care coordination services and quality outcomes for patients across the continuum. Promotes effective utilization and monitoring of health services, collaborates and communicates with the healthcare team and patient/caregiver to manage care and transitions. Develops and/or implements a comprehensive care plan based on assessment and evaluation of patient/caregiver needs. Functions in one of the following practice settings: Acute Care, Service Lines, Ambulatory/Community-based, Home Health, and Long Term Care.

BLS required within 90 days of hire and maintained thereafter (if in clinical setting)

In Behavioral Health – De-escalation and physical intervention training within 15 days of hire.

For Integrated Care Management departments, specialty certification required within one year of eligibility (ACM, CCM, CCCTM, CMAC or CGMT-BC). For other service lines, certification based on specialty area required within one year of eligibility.

3 years Case Management experience preferred.

For those in Behavioral Health – Certification in de-escalation training within 15 days of hire and annually.

PACE specific incumbents for this position require a minimum of one year of experience working with the frail or elderly population.

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 License (RN) – Compact/Multi-State License, Registered Nurse License (RN) – North Carolina, Registered Nurse License (RN) – Virginia

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.