Utilization Management - Nurse Manager
10000 Sanford(2 months ago)
About this role
The Utilization Review and Case Management Manager at Sanford Health leads the utilization management program to standardize care authorization and transitions across the continuum. The role focuses on aligning utilization strategies with regulatory standards (including CMS) and optimizing value and outcomes for designated patient populations. The manager also serves as the departmental leader supporting staff development and organizational quality improvement.
Required Skills
- Utilization Review
- Case Management
- Medical Necessity
- Clinical Documentation
- Payer Relations
- Appeals Management
- Team Leadership
- Process Improvement
- Staff Scheduling
- Admissions Certification
Qualifications
- Bachelor's Degree in Nursing
- Master's Degree in Nursing (Preferred)
- Graduation from Accredited Nursing Program (CCNE/ACEN/NLN CNEA)
- Registered Nurse (RN) License
- Nurse Licensure Compact (NLC) Multistate Licensure (If Applicable)
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