- Humana (Pierre, SD)
- …a part of our caring community and help us put health first** The Weekend 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
- 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
- Cognizant (Pierre, SD)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Lincoln Financial (Pierre, SD)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Sanford Health (Rapid City, SD)
- …community. **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
- CVS Health (Pierre, SD)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years post… more
- Sharecare (Pierre, SD)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- CVS Health (Pierre, SD)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Avera (Sioux Falls, SD)
- …Provide all cares to include lab draws, nebulizer treatments, wound care, case management , discharge planning and as needed cares. Responsible for the care planning, ... utilization of services, coordination of care, and the education...and the education of the interdisciplinary teams in the management of patient care services. Develops all patient care… 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
- Evolent (Pierre, SD)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… 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
- Highmark Health (Pierre, SD)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Evolent (Pierre, SD)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… 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
- Highmark Health (Pierre, SD)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures,...and management . + Route Cases Based on Established Guidelines. +… 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
- Sanford Health (Rapid City, SD)
- …is a vital part of that mission - providing compassionate, evidence-based pain management that restores hope and quality of life to patients across the region. ... our next Pain Clinic Supervisor. This isn't just a management role - it's a chance to shape a...nursing staff to specific shifts, taking into account past utilization trends. Responsible to implement the nursing process within… more
- Sanford Health (SD)
- …three years of recent clinical nursing experience required. Experience in case management , utilization management , and/or coding preferred. If working ... written/verbal communication, critical thinking, creative problem solving, and conflict management skills. Proficient in organization and planning. Possess strong… more