[Hiring] Integrated Nurse Case Manager/Registered Nurse (RN) for Inpatient and Outpatient Clinical Appeals @Sentara Health

Role Description

Sentara Health Plans is hiring an Integrated Nurse Case Manager/Registered Nurse (RN) for Inpatient and Outpatient Clinical Appeals- 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
• Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance
• Legal Resources Plan
• Colleagues may have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met

Company Description

Sentara Health is an integrated, not-for-profit health care delivery system, celebrating 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, with:

• 34,000 employees
• 12 hospitals in Virginia and Northeastern North Carolina, including 10 hospitals with the prestigious Magnet®️ recognition
• The Sentara Health Plans division which serves more than 1 million members in Virginia and Florida

Sentara is recognized nationally for clinical quality and safety and is strategically focused on innovation and creating an extraordinary health care experience for our patients and members.

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.