- Sanford Health (Rapid City, SD)
- …providing direct supervision of all departmental staff. Maintains a standardization of utilization management process to ensure all policies and procedures are ... Hours:** 40.00 **Department Details** Join our team as a Utilization Review and Case Management Manager and...medical necessity review preferred. Currently holds an unencumbered registered nurse (RN) license with the State Board of Nursing… 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
- Humana (Pierre, SD)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… 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
- Evolent (Pierre, SD)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- Sanford Health (Sioux Falls, SD)
- …in the functions of the applicable technical software setting and process/ utilization improvement. Improves clinical patient care processes for quality patient ... and supports human resources administrative processing and procedures with staff management . May assist with providing feedback in the collection and preparation… more
- Avera (Scotland, SD)
- …offer quality care close to home. **Position Highlights** **Seeking a Registered Nurse (RN) to join our team at Landmann-Jungman Memorial Hospital.** **SUMMARY:** ... preferred. **CERTIFICATION, LICENSURE, and/or REGISTRATIONS:** + Current licensure as a Registered Nurse in the State of South Dakota and/or meeting the requirements… more
- Avera (Mitchell, SD)
- …both clinically and administratively. As the off shift representative of management , supervises staff and makes administrative decisions, which may involve patients ... personnel/patient issues in the absence of clinical leaders. + Coordinates utilization of resources including staff, ancillary staff, equipment and facilitates… 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)
- …+ Care Management Certification + Demonstrated experience in case management , utilization review, or discharge planning. + Bi-Lingual/Spanish Speaking ... The RN Ambulatory Care Manager I delivers comprehensive ambulatory care management services to identified patients. Leveraging clinical expertise, this role involves… 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
- STG International (Pierre, SD)
- …to ensure compliance and patient safety. *Participates in quality improvement, care management , risk management , peer review, utilization review, clinical ... in the orientation of clinical staff physicians, physician assistants and nurse practitioners. *Provide leadership to CBOC clinicians. *Evaluate the effectiveness of… more
- Highmark Health (Pierre, SD)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more
- CVS Health (Pierre, SD)
- …health outcomes by engaging telephonically with individuals living with diabetes. This nurse will guide members through actionable steps to close gaps in care, ... education, connecting members to resources, and facilitating referrals to care management programs for continued support. This position supports the development and… more
- Sanford Health (Sioux Falls, SD)
- …three years of recent clinical nursing experience required. Experience in case management , utilization management , and/or coding preferred. Currently holds ... written/verbal communication, critical thinking, creative problem solving, and conflict management skills. Proficient in organization and planning. Possess strong… more
- Good Samaritan (Watertown, SD)
- …providers to plan, implement and evaluate care. Includes personal care management , medication administration, care planning, scheduling physician visits, setting up ... in the functions of the applicable technical software setting and process/ utilization improvement. Assists and supports human resources administrative processing and… more
- Sanford Health (Aberdeen, SD)
- …with scheduling nursing staff to specific shifts, taking into account past utilization trends. Responsible to implement the nursing process within Sanford and the ... Functions within the scope and standards of nursing practice as outlined in the Nurse Practice Act and Administrative Rules in state of practice and licensure. The… 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
- 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
- Oracle (Pierre, SD)
- …alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal candidate ... sessions, and offer ongoing consultation to support user proficiency and system utilization . Monitor project outcomes, track key metrics, and report progress to… more