Utilization Management Specialist

Job description

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We’re proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint. Work Shift: Day (United States of America) Scheduled Weekly Hours: 40 Salary Range: $24.00 - $38.50: Union Position: No Department Details: Join the Health Plan Utilization Management team and leverage your RN expertise to conduct medical necessity reviews to ensure members receive appropriate, high-quality care. Core Hours: Monday through Friday, 8am to 5pm, No weekends or holidays Summary: 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 with applicable. Completes activities relating to determination of medical necessity, authorization, continued stay review includi...