RN Supervisor-Commercial Hospital Utilization Review

City/State

Work Shift

Overview:

Sentara Health Plan is hiring a Full-Time Day-shift

RN Supervisor for the Commercial Utilization Review Hospital and Behavioral Health team

Assumes responsibility, accountability, and leadership for the daily operations, including coordination of work, quality, and service. First-line supervisor in the Department of Medical Care Management for assigned site/function. Facilitates the work of assigned team members. Provides a leadership role in ongoing case manager competency assessment, needs identification, and educational offerings. Provides educational services to the Medical Care Management staff. Participates in the work activities of assigned teams and provides case management services as needed.

Education

• BSN required

Certification/Licensure

• Valid RN license
• 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.

Experience

• 3 years of Case Management/Utilization Review RN experience required.
• 1 year of Leadership experience required.
• Experience with JIVA, Epic, and QNXT experience preferred.
• Proficient with MCG guidelines
• Experience with Behavioral Health Inpatient and Outpatient authorizations and denials preferred.

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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.