Sanford Health
10,000+ employees
Founded 1894
⚕️ Healthcare Insurance
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.
Utilization Management Specialist – Prior Authorization
Job not on LinkedIn
🔥 25 minutes ago
🌾 North Dakota, Minnesota, +1 more states – Remote
💵 $27 - $38 / hour
⏱ Part Time
🟡 Mid-level
🟠 Senior
🦅 H1B Visa Sponsor
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Sanford Health
10,000+ employees
Founded 1894
⚕️ Healthcare Insurance
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
• Conduct level of care medical necessity reviews within patient’s medical records. • Performs utilization management (UM) activities in accordance with UM plan to assure compliance with accreditation/regulatory requirements. • Completes/coordinates activities relating to the implementation, ongoing evaluation, and improvements to UM and/or prior authorization processes. • Completes activities relating to determination of medical necessity, authorization, continued stay review including diagnosis and procedural coding. • Ensure validation of appropriate level of care for pre-admission surgical reviews prior to admission. • Collaborates with physicians and other clinical professionals as needed to assist in documentation improvement practices for effective and appropriate services. • Educates members of the healthcare team regarding trends, external regulations and internal policies that affect resource utilization and potentially, prior authorization. • Assist in report preparation, correspondence, and maintenance of appropriate records.
🎯 Requirements
• Bachelor's degree in nursing preferred. • Graduate from a nationally accredited nursing program required, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA). • Currently holds an unencumbered registered nurse (RN) license with the State Board of Nursing. • Obtains and subsequently maintains required department specific competencies and certifications.
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