SD Licensed Lead UM Specialist

Job Summary

Serving as a subject matter expert for appeals and denials, the full-time remote SD Licensed Lead UM Specialist will provide leadership, oversee case management, and ensure quality assurance across the appeals process while collaborating with multiple departments.

Key responsibilities

• Lead team meetings and mentor staff on complex issues related to appeals and denials
• Conduct reviews of clinical-based denials and ensure compliance with audit practices and regulations
• Develop process improvement initiatives and maintain high standards of quality assurance

Required qualifications

• Bachelor's degree in nursing preferred; graduation from a nationally accredited nursing program required
• Three years of related experience in healthcare
• Current unencumbered registered nurse (RN) license with the State Board of Nursing
• Certified Professional in Healthcare Quality preferred
• Ability to obtain and maintain required department-specific competencies and certifications