Remote RN - Claims Reviewer & Utilization Review

Sentara Health Plans is hiring a Clinical Claims Reviewer/RN. The role focuses on utilization management, pre/post payment claim reviews, and authorization assessments for various care settings.

Remote work options are available, with a background in acute care nursing and coding required. The successful candidate will ensure compliance with state and federal guidelines, including CMS and NCQA, and will handle post-payment inquiries and potential reconsiderations.

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