RN Team Coord Commercial Utilization Review (VA/NC)

*BSN

*Valid RN License

*Three years of Utilization Review/Case Management experience.

*Supervisory experience with Managed Care and Commercial Insurance Prior Authorizations preferred.

*Epic EMR, Wintegrate CSC, and JIVA platform experience preferred.

*Knowledge of NCQA Health Plan standards and audits.

Remote - work from home is available only in Virginia or North Carolina.

During orientation, overnight travel to Sentara Park in Virginia Beach may be required.

Responsibilities:

*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.

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

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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