Manager, Utilization Management

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: 8 Hours - Day Shifts (United States of America) Scheduled Weekly Hours: 40 Union Position: No Department Details: Oversee health plan utilization management department operations including prior authorization, and concurrent review focusing on improving care quality and outcomes across a diverse member population while ensuring compliance with CMS, NCQA, and state/federal guidelines. Summary: Responsible for the day to day oversight of department function both in terms of provision of service and providing direct supervision of all departmental staff. Maintains a standardization of utilization management process to ensure all policies and procedures are followed effectively and efficiently. Job Description: Considered an expert resource with the centers for Medicare and Medicaid services (CMS). Coordinates authorization/certification of care for designated populations...