City/State

Work Shift

Overview:

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

Status: Full-timepermanent 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 34000 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 Americas Best-In-State Employer (2024) Best Employer for Veterans () and Best Employer for Women (2020) and named to IBM Watson Healths Top 15 Health Systems ().

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 and use the following as your Keyword Search: JR-97914

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

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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 30000-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.