Sanford Health
10,000+ employees
Founded 1894
🛡️ Insurance
🏥 Healthcare
⚕️ Healthcare Insurance
Insurance • Healthcare • Healthcare Insurance
Sanford Health is the largest rural health system in the United States, dedicated to transforming the healthcare experience and providing access to world-class healthcare in America's heartland. Headquartered in Sioux Falls, South Dakota, Sanford Health serves over 1. 4 million patients and nearly 200,000 health plan members across 250,000 square miles. The integrated health system includes 48 medical centers, 211 clinic locations, and more than 160 senior living centers, employing 2,900 physicians and advanced practice providers. Sanford Health is committed to offering compassionate care through its Centers of Excellence, focusing on specialties such as cancer, orthopedics, women’s health, and genetics. Additionally, it provides affordable health insurance, engages in extensive clinical trials, and supports personalized genetic medicine.
Lead Utilization Management Specialist – Appeals
🔥 0 minutes ago
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Sanford Health
10,000+ employees
Founded 1894
🛡️ Insurance
🏥 Healthcare
⚕️ Healthcare Insurance
Insurance • Healthcare • Healthcare Insurance
Sanford Health is the largest rural health system in the United States, dedicated to transforming the healthcare experience and providing access to world-class healthcare in America's heartland. Headquartered in Sioux Falls, South Dakota, Sanford Health serves over 1. 4 million patients and nearly 200,000 health plan members across 250,000 square miles. The integrated health system includes 48 medical centers, 211 clinic locations, and more than 160 senior living centers, employing 2,900 physicians and advanced practice providers. Sanford Health is committed to offering compassionate care through its Centers of Excellence, focusing on specialties such as cancer, orthopedics, women’s health, and genetics. Additionally, it provides affordable health insurance, engages in extensive clinical trials, and supports personalized genetic medicine.
📋 Description
• Serves as the subject matter expert for appeals and denials • Provides leadership, case oversight, workflow coordination, and quality assurance across the appeals process • Develops process improvement initiatives and problem solving • Collaborates with multiple departments • Assists the supervisor in quality assurance and accreditation monitoring • Conduct review of clinical-based denials within required timeframes • Ensures compliance with current government and industry audit practices and requirements • Mentors others in their technical areas and shares expertise on critical issues
🎯 Requirements
• Bachelor's degree in nursing preferred • Graduate from a nationally accredited nursing program required • Three years of related experience required • Currently holds an unencumbered registered nurse (RN) license with the State Board of Nursing • Certified Professional in Healthcare Quality preferred
🏖️ Benefits
• Fully Remote • Monday - Friday • 8am-5pm
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