RN UM Specialist: Care Optimization & Remote-Ready

RiseMe; South Dakota; On-site; USD 39,000 - 52,000; Full time

Job summary

Sanford Health in the United States is seeking a qualified RN to perform utilization management and medical necessity reviews within patient records. This role supports the UM plan to ensure compliance with accreditation and regulatory requirements and coordinates prior authorizations and DRG coding where applicable.

Work is primarily daytime, 8-hour shifts, with potential remote work after 6 months to 1 year.

Qualifications

• Bachelor's degree in nursing preferred; graduate from a nationally accredited nursing program.
• Unencumbered RN license in the state.
• Maintains required competencies and department-specific certifications.

Responsibilities

• Conduct level of care medical necessity reviews within patient records.
• Perform utilization management activities to ensure compliance with accreditation and regulatory requirements.
• Coordinate activities related to implementation and evaluation of UM and prior authorization processes.
• Collaborate with healthcare team to promote medically necessary resource utilization and fiscal outcomes.

Skills

Interpersonal skills

Education

Bachelor's degree in nursing (preferred)

RN license (state-specific)

CCNE/ACEN/NLN CNEA certifications (optional)

Job description

Sanford Health in the United States is seeking a qualified RN to perform utilization management and medical necessity reviews within patient records. This role supports the UM plan to ensure compliance with accreditation and regulatory requirements and coordinates prior authorizations and DRG coding where applicable.

Work is primarily daytime, 8-hour shifts, with potential remote work after 6 months to 1 year.