Integrated Nurse Case Manager/Registered Nurse (RN) for Inpatient and Outpatient Clinical Appeals- Remote in Virginia!
City/State Virginia Beach, VA Work Shift First (Days) Overview: Sentara Health Plans is hiring an Integrated Nurse Case 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 Overview: 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 Education: N-3YR - RN-Diploma (Non-degree) REQUIRED; Bachelors Degree in Nursing preferred Certification/Licensure: Registered Nurse (RN) License (Compact or Virginia) preferred Experience: 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 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, with 34,000 employees, 12 hospitals in Virginia and Northeastern North Carolina, including 10 hospitals with the prestigious Magnet®️ recognition, and 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 was named a Health Quality Innovator of the Year (2024), was recognized by Forbes as "America’s Best-In-State Employer” (2024), "Best Employer for Veterans" (2022, 2023), and "Best Employer for Women" (2020), and named to IBM Watson Health's "Top 15 Health Systems" (2021, 2018). 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! To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-102136 Talroo – Nursing Managed Care, MCO, Health Plan, Healthcare, Health Insurance, Nursing, RN, Registered Nurse, Appeals, Inpatient, Outpatient, Denial, Provider, Case management, clinical, Utilization Review, Claims, Revenue Cycle . Benefits: Caring For Your Family and Your Career
- 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
Sentara Independence provides quality outpatient services to the surrounding community. The facility includes an ambulance-accessible emergency room that is supported by board-certified physicians. Sentara Independence houses state-of-the-art medical equipment and highly-skilled physicians and staff. Sentara Independence is now an extension of the quality services at Sentara Virginia Beach General Hospital including advanced imaging and physical therapy. 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.