- Sanford Health (Rapid City, SD)
- …Schedule:** Full time **Weekly Hours:** 40.00 **Department Details** Join our team as a Utilization Review and Case Management Manager and lead a ... providing direct supervision of all departmental staff. Maintains a standardization of utilization management process to ensure all policies and procedures are… more
- CenterWell (Pierre, SD)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Avera (Sioux Falls, SD)
- …eligible for a $10,000 Sign on Bonus** **Student Loan Repayment:** This Registered Nurse (RN) position may be eligible for Avera's Student Loan Repayment Program, ... where you matter.** **A Brief Overview** Responsible for the care planning, utilization of services, coordination of care, and the education of the interdisciplinary… more
- Avera (Sioux Falls, SD)
- …face of Avera@Home. + Establishes operational systems to insure maximum resource utilization and financial performance of the clinical continuum of care. + ... proactive communication with physicians, identification and referral of risk management concerns, and initiation of appropriate follow-up. + Maintains current… more
- Intermountain Health (Pierre, SD)
- **Job Description:** The RN Ambulatory Care Manager I delivers comprehensive ambulatory care management services to identified patients. Leveraging clinical ... expertise, this role involves conducting care management screenings, assessments, and evaluations. The manager ... Management Certification + Demonstrated experience in case management , utilization review, or discharge planning. +… more
- Sanford Health (Sioux Falls, SD)
- …weekend) **Job Summary** Provides expertise and leadership to ensure effective resource management for patient care delivery across the care continuum for assigned ... patient wellness through evidenced based practice, improved care outcomes, efficient utilization of health services, and appropriate level of care for patients… more
- STG International (Pierre, SD)
- …to ensure compliance and patient safety. *Participates in quality improvement, care management , risk management , peer review, utilization review, clinical ... /coordination of the clinic's day-to-day activity, in conjunction with the Registered Nurse (RN)/CBOC Manager and VA Program's philosophy. *Comply with all… more
- Sharecare (Pierre, SD)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Edwards Lifesciences (Sioux Falls, SD)
- …an impact:** + Working independently in the areas of valve crimping, case management , pre-case planning, post-case management , 3 Mensio management , Therapy ... implementing growth strategies within focused accounts in partnership with Sales Management . + Developing clinical champions among current and potential customers… more