Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.
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Facility: Cherapa Place Building
Location: Sioux Falls, SD
Address: 300 N Cherapa Pl, Sioux Falls, SD 57103, USA
Shift: 8 Hours - Day Shifts
Job Schedule: Full time
Weekly Hours: 40.00
Responsible for managing the referral and authorization system for participating members and contracted providers ensuring that all services are performed at the appropriate level of care in a timely, cost-effective and efficient manner. Additionally, will serve as a liaison/consultant regarding medical coverage and policies to other health plan departments. Ability to review, analyze and summarize reports and have effective oral and written communication skills. Understanding of medical terminology, typing or word processing skills and a familiarity with computers. Demonstrate excellent telephone skills and legible handwriting. Knowledge of international classification of diseases, tenth revision (ICD-10) codes and current procedural terminology (CPT) codes. Functional understanding of the medical, administrative and management principles necessary to operate within a managed care organization. Exposed to multiple settings for utilization review, including inpatient and ambulatory.
Graduate from an accredited nursing program as a Licensed Practical Nurse (LPN) or Medical Assistant (MA).
One year of clinical experience preferred. Background in medical claims or other utilization review experience desired. Typing speed of 40+ words per minute (wpm) is preferred.
Nationally certified or registered as a Medical Assistant (MA), or currently holds an unencumbered Licensed Practical Nurse (LPN) license with State Nursing board and/or possess multi-state licensure privileges.
Certification (CMA) obtained through a nationally approved certification program for medical assistant, including but not limited to, the American Association of Medical Assistants (AAMA), or National Certified Medical Assistant (NCMA) through the National Center for Competency Testing (NCCT), etc. Registration (RMA) obtained through the American Medical Technologists (AMT) also acceptable.
Additional state requirements include South Dakota (SD) registration as a MA through the SD Board of Medical and Osteopathic Examiners. North Dakota (ND) registration as an MAIII through the ND Board of Nursing. MAs working within Minnesota (MN) and Iowa (IA) do not require state registration.
Obtains and subsequently maintains required department specific competencies and certifications.
Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, sick leave and paid time off. To review your benefit eligibility, visit https://sanfordhealth.jobs/benefits .
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 firstname.lastname@example.org .
Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.
Job Function: Care Coordination
Req Number: R-50334