[Hiring] Integrated Care Manager/Registered Nurse @Sentara Health

Role Description

Sentara Health Plans is hiring an Integrated Care Manager/Registered Nurse (RN) for Inpatient and Outpatient Clinical Appeals- Remote in Virginia!

• Status: Full-time, permanent position (40 hours)
• Standard working hours: 8am to 5pm EST, M-F
• Location: Remote in Virginia

• Manage inpatient and outpatient provider appeals across all payer types, including government and commercial insurance.
• Review clinical denials (non-billing related), identify root causes, and perform post-claim analysis to support appeal submissions.

Qualifications

• N-3YR - RN-Diploma (Non-degree) - REQUIRED
• Bachelors Degree in Nursing - preferred
• Registered Nurse (RN) License (Compact or Virginia) - preferred
• 3 years experience in Nursing - REQUIRED
• Experience/knowledge in Rev Cycle, Utilization Review (UR) and Case Management - preferred
• Provider appeals experience is a plus
• Strong proficiency in Excel

Benefits

• 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
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

Company Description

Sentara Health, an integrated, not-for-profit health care delivery system, celebrates more than 135 years in pursuit of its mission - "we improve health every day." Sentara is one of the largest health systems in the U.S. Mid-Atlantic and Southeast, and among the top 20 largest not-for-profit integrated health systems in the country.

• 34,000 employees
• 12 hospitals in Virginia and Northeastern North Carolina
• 10 hospitals with the prestigious Magnet®️ recognition
• Sentara Health Plans division serves more than 1 million members in Virginia and Florida
• Recognized nationally for clinical quality and safety
• Strategically focused on innovation and creating an extraordinary health care experience for patients and members
• Named a Health Quality Innovator of the Year (2024)
• Recognized by Forbes as "America’s Best-In-State Employer” (2024)
• Best Employer for Veterans (2022, 2023)
• Best Employer for Women (2020)
• Named to IBM Watson Health's "Top 15 Health Systems" (2021, 2018)