Sanford Health is seeking a home-based Utilization Management Specialist to conduct medical necessity reviews and manage prior authorizations. Ideal candidates should have a nursing background, particularly as a registered nurse, and possess strong interpersonal skills to collaborate effectively within a healthcare team
Job Summary
Conduct level of care medical necessity reviews within patient’s medical records and perform utilization management (UM) activities in accordance with UM plan.
Reviews include InterQual clinical decision support criteria to ensure both the appropriateness of medical services and effective cost control.
Educates members of the healthcare team regarding trends, external regulations and internal policies that effect resource utilization and potentially, prior authorization.
Matching Summary
Match Score: 85
Sanford Health is seeking a home-based Utilization Management Specialist to conduct medical necessity reviews and manage prior authorizations. Ideal candidates should have a nursing background, particularly as a registered nurse, and possess strong interpersonal skills to collaborate effectively within a healthcare team.