RN Utilization Management Specialist — Remote After 6 Months

Good Samaritan Society

Sioux Falls, Northern (SD, KY)

Hybrid

USD 59,000 - 80,000

Full time

4 days ago

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Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Life insurance

401(k) retirement plan

Work/life balance benefits

Generous time off

Job summary

Sanford Health in Sioux Falls, SD is seeking a Registered Nurse to conduct level of care medical necessity reviews within patient records. You will perform utilization management activities to assure compliance with accreditation and regulatory requirements, and support pre‑authorization processes, documentation, and DRG coding for working diagnoses.

Collaborate with physicians and healthcare teams to promote appropriate resource utilization, educate on payer standards, and help monitor quality

Qualifications

Bachelor's degree in nursing preferred.
Graduate from a nationally accredited nursing program (CCNE, ACEN, NLN CNEA).
Currently holds an unencumbered RN license with the State Board of Nursing.

Responsibilities

Conduct level of care medical necessity reviews within patient's medical records.
Perform utilization management activities to ensure compliance with accreditation and regulatory requirements.
Coordinate prior authorizations and DRG coding for working diagnoses.
Collaborate with physicians and healthcare professionals to promote appropriate resource utilization.