- CVS Health (Pierre, SD)
- …+ Active and good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC ... experience working within the mental health system. + Previous experience with utilization management . + Ability to collaborate with various internal… 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in the… more
- CenterWell (Pierre, SD)
- …clinical experience. + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Intelligence + ... put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...Experience with Home Health preferred + Previous experience in utilization management within Insurance industry a plus… 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 ... + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital… more
- CVS Health (Pierre, SD)
- …is subject to change based on business needs. **Preferred Qualifications** 6+ months Case Management or Utilization Management experience Case Management ... however, it is subject to change based on business needs.** The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating… more
- Avera (Scotland, SD)
- …join our team! We offer quality care close to home. **Position Highlights** **Seeking a Registered Nurse ( RN ) to join our team at Landmann-Jungman Memorial ... professional level of behavior in her/his role as an RN . The American Nurses Associations (ANA) scope and standards...**CERTIFICATION, LICENSURE, and/or REGISTRATIONS:** + Current licensure as a Registered Nurse in the State of South… more
- Avera (Sioux Falls, SD)
- …schedule **May Be eligible for a $10,000 Sign on Bonus** **Student Loan Repayment:** This Registered Nurse ( RN ) position may be eligible for Avera's Student ... cause undue hardship to the employer. **Required Education, License/Certification, or Work Experience:** + Registered Nurse ( RN ) - Board of Nursing Upon Hire… more
- Avera (Pierre, SD)
- …cause undue hardship to the employer. **Required Education, License/Certification, or Work Experience:** + Registered Nurse ( RN ) - Board of Nursing An active ... License/Certification, or Work Experience:** + 1-3 years clinical experience as RN + supervisory or management experience **Expectations and Standards**… more
- Humana (Pierre, SD)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- Sanford Health (Sioux Falls, SD)
- …business need, prior to new Sanford education requirements. Three years' experience as a registered nurse ( RN ) in a clinical role preferred. Thorough ... act and standards of nursing care, and a working knowledge of administrative and management techniques. Currently holds an unencumbered RN license with the State… more
- Healthfirst (SD)
- The Case Manager, Utilization Management coordinates the care plan for assigned members and conducts pre-certification, concurrent review, discharge planning, ... case management as assigned. The Case Manager, Utilization Management is also responsible for efficient...necessary + Additional duties as assigned Minimum Qualifications: + RN , LPN, LMSW, LMHC, LMFT, LCSW, PT, OT, and/or… 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 ... in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… 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 ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder… more
- CVS Health (Pierre, SD)
- …+ 5-7 years of regulatory and/or clinical audit experience. + Experience in medical management , including Utilization Management (UM) and Case Management ... accreditation processes, and NCQA standards. + Licensed clinical professional ( RN preferred). + Excellent analytical, organizational, and communication skills. +… 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
- 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
- Evolent (Pierre, SD)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... in a regulatory role (preferred). **LICENSE/CERTIFICATION:** Current, unrestricted state PA or RN /NP license in medicine or required specialty. Of a PA, obtaining a… 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)
- … management /coordination of the clinic's day-to-day activity, in conjunction with the Registered Nurse ( RN )/CBOC Manager and VA Program's philosophy. ... to ensure compliance and patient safety. *Participates in quality improvement, care management , risk management , peer review, utilization review, clinical… more