Medical Policy Research Specialist/ Registered Nurse (RN) - Remote in Virginia

Norfolk, VA • First shift (Days) • Full-time, permanent position (40 hours per week)

About the role

Sentara Health Plan is hiring a remote Medical Policy Research Specialist / Registered Nurse (RN) based in Virginia. The role involves ongoing identification and research of medically evidence-based clinical technologies to support clinical decision-making, medical policy, and benefit development. Monthly travel to Sentara Park 133 in Virginia Beach, VA is expected for candidates in the Hampton Roads area.

Responsibilities

• Maintain a database of clinical criteria and ensure technology and policy reviews are conducted annually or as needed to meet Federal, State, and Accreditation Standards.
• Stay proficient with evolving national guidelines, new medical treatments, and devices; compile information on clinical indications, alternative technologies, and expected outcomes.
• Perform comprehensive clinical literature reviews, assess legal and regulatory status of technologies, and review Federal, State, and local coverage determinations.
• Identify current coverage policies and procedures.
• Collaborate with Medical Directors and teams on updates to clinical guidelines, medical policies, and regulatory guidance.

Requirements

• Bachelor’s degree in Nursing (required).
• Active RN license in Virginia or a Compact/Multistate license (required).
• 3+ years of experience in clinical criteria coverage (required).
• 3+ years of experience in Managed Care (required).
• Knowledge of medical policy, emerging technology, and analysis of emerging evidence (required).
• Familiarity with primary clinical literature, clinical guidelines, and/or medical policies.
• Working knowledge of PubMed and literature search methodology.
• Experience with Imaging/Radiology (preferred).
• Experience with the policy writing process (preferred).
• Ability to assimilate and work through data sets (preferred).

About Sentara Health Plan

Sentara Health Plans provides health plan coverage to nearly one million members in Virginia. Offerings include commercial products (employer-sponsored and employee-owned plans), Individual & Family Health Plans, Employee Assistance Programs, and plans for Medicare and Medicaid enrollees. The organization features a robust provider network and programs supporting members with chronic illnesses, wellness initiatives, and integrated clinical and behavioral health services.

Benefits

• Medical, dental, and vision plans.
• Adoption, fertility, and surrogacy reimbursement up to $10,000.
• Paid time off and sick leave.
• Paid parental and family caregiver leave.
• Emergency backup care.
• Long-term, short-term disability, and critical illness plans.
• Life insurance.
• 401k/403B with employer match.
• Tuition assistance up to $5,250/year and discounted educational opportunities through Guild Education.
• Student debt pay down up to $10,000.
• Pet insurance.
• Legal resources plan.
• Opportunity to earn an annual discretionary bonus if system and employee eligibility criteria are met.