- Actalent (Sioux Falls, SD)
- Job Title: Post Review Nurse - Utilization Management Job Description We are seeking a diligent and detail-oriented Post Review Nurse to perform timely ... and quality of our healthcare services. Responsibilities + Conduct utilization management reviews and claims assessments using...HIPAA, ICD, and CPT. + Completion of an accredited RN or LPN program. + Active, unrestricted RN… 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
- 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 (Mitchell, 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
- Select Medical (Sioux Falls, SD)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,...**Current licensure in a clinical discipline either as a Nurse ( RN /LPN/ LVN)or a Respiratory Therapist… 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 ... and communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- Healthfirst (SD)
- …Experience in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management /case management . ... all levels of the appeal process + Additional duties as assigned Minimum Qualifications: + RN , LPN OR Dental Hygienist Preferred Qualifications: + Bachelors degree +… more
- Intermountain Health (Pierre, SD)
- …/Professional Nursing program. + Required Licensure/Certification: State licensure as a Registered Nurse ( RN ). Preferred Qualifications + Bachelor's ... cost-effective outcomes. Provides focused support to various areas such as utilization management , emergency department, acute, ambulatory and specialty care.… 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
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