Sentara Health Plan is hiring a Full-Time Day-shift

RN Supervisor for the Commercial Utilization Review Hospital and Behavioral Health team

Assumes responsibility, accountability, and leadership for the daily operations, including coordination of work, quality, and service. First-line supervisor in the Department of Medical Care Management for assigned site/function. Facilitates the work of assigned team members. Provides a leadership role in ongoing case manager competency assessment, needs identification, and educational offerings. Provides educational services to the Medical Care Management staff. Participates in the work activities of assigned teams and provides case management services as needed.

Education

• BSN required

Certification/Licensure

• Valid RN license
• For Integrated Care Management departments, specialty certification is required within one year of eligibility (ACM, CCM, CCCTM, CMAC, or CGMT-BC). For other service lines, certification based on specialty area is required within one year of eligibility. 

Experience

• 3 years of Case Management/Utilization Review RN experience required.
• 1 year of Leadership experience required.
• Experience with JIVA, Epic, and QNXT experience preferred.
• Proficient with MCG guidelines
• Experience with Behavioral Health Inpatient and Outpatient authorizations and denials preferred.

keywords: LinkedIn, Nursing Acute Care, Full Time, Case Management, RN, Registered Nurse, BSN, Talroo-Nursing, Monster, care coordinator, utilization review, authorization, denials, medical director, compliance, regulation, medical necessity, service lines, ACM, CCM, TCM, CMAC or CGMT-BC, MCG, Behavioral Health, JIVA, Epic, QNXT