LPN Associate Utilization Management Coordinator | Health Plan
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
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.
Prefer LPN license.
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 is an EEO/AA Employer M/F/Disability/Vet.
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Job Function: Care Coordination
Req Number: R-27824