Sanford Health RN Utilization Management Specialist HB - Patient Access Management in Sioux Falls, South Dakota

Job Title: RN Utilization Management Specialist HB | Patient Access Management | Multi-City

City: Bismarck

State: Multi-State


Job Schedule: Full Time

Shift: Days

Hours Per Shift: 8 hr


Performs utilization management activities in accordance with Utilization Management Plan to assure compliance with accreditation/regulatory requirements. Completes/coordinates activities relating to the implementation, ongoing evaluation and improvements to utilization management processes and/or prior authorization processes. Completes activities relating to determination of medical necessity, authorization, continued stay review and outlier review including diagnosis and procedural coding for working diagnosis related group (DRG) assignment. Collaborates with members of the healthcare team to promote medically necessary resource utilization and achievement of fiscal outcomes. Assists in report preparation, correspondence and maintenance of appropriate records. Educates members of the healthcare team regarding trends, external regulations and internal policies that effect resource utilization and prior authorization. Organizational and communication skills. Dynamic and tactful interpersonal skills, particularly in relating to physicians and other health care professionals. Critical thinking and problem solving skills. Ability to organize complex systems of data. Ability to work effectively with both people and data including detailed information. Data management, retrieval and analysis skills. Knowledge of statistics and statistical data displays. Personal commitment to quality of care. #featuredjob


Adjusts to new or changing assignments, processes, and people. Applies available tools and resources to work efficiently. Assists in assessing risks, benefits and consideration of alternatives. Assists patients in accessing specialized providers through the use of referrals or pre-approvals. Delivers written and oral communication, responds to questions and concerns, and produce specific outcomes and impact. Demonstrates experience engendering collaborative processes that lead to problem solving and the achievement of business goals. Follows-up with customers to answer questions and ensure satisfaction. Helps promote collaboration across generations, functions, regions, and levels. Identifies potential changes that reduce costs without impacting the quality of patient care. Maintains sense of commitment to success, personal achievement and satisfaction. Organizes and prioritizes the sequence of steps to be taken to remedy the situation. Utilizes specific approaches and tools for checking and cross-checking outputs. Verifies if collected data is appropriate for reimbursement, utilizing related legal guidelines.


Full-time, 40 hours a week, weekday hours. Opportunity to work from home once training is successfully completed. Position can be filled in Sioux Falls, Fargo, Bismarck, or Bemidji region.


Currently holds an unencumbered registered nurse (RN) license with the State Board of Nursing. Obtains and subsequently maintains required department specific competencies and certifications. Bachelor's degree in nursing preferred. Graduate from a nationally accredited nursing program required, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA).

About Sanford Health:

At Sanford Health, we are dedicated to the work of health and healing.

Every day, we show that commitment by delivering the highest quality of care to the communities we serve.

We are leaders in health care and strive to provide patients across the region with convenient access to expert medical care, leading-edge technologies and world-class facilities.

In addition to strong clinical care, we are also committed to research, education and community growth.

We engage in medical research to not only discover innovative ways to provide care, but also cures for common diseases.

We continuously seek new ways to achieve our vision of improving the human condition here in your community,

across the region and around the world.

The entire team at Sanford Health recognizes the value of healthy families and communities.

We continue to gain momentum and expand our reach. Together, we can make a positive difference now, and in the future.

Sanford is an EEO/AA Employer M/F/Disability/Vet.

If you are an individual with a disability and would like to request an accommodation for help with your online application,

please call 1-877-673-0854 or send an email to .

In compliance with federal law requiring employers to verify new employees' U.S.

employment eligibility, Sanford participates in E-Verify. To learn more click here for English Version at or here for Spanish Version at .

City: Multi-City

State: Multi-State

Job Function: Revenue Cycle

Job Schedule: Full Time

Shift: Days

Req Number: req22203