South Dakota Licensed Utilization Specialist

Job Summary

Conducting level of care medical necessity reviews, the part-time South Dakota Licensed Utilization Specialist will perform utilization management activities, ensuring compliance with accreditation requirements and collaborating with healthcare teams to optimize resource utilization in a remote setting.

Key responsibilities

• Conduct medical necessity reviews and manage prior authorizations and insurance denials
• Collaborate with healthcare professionals to promote appropriate resource utilization and documentation improvement
• Monitor compliance with regulatory requirements and assist in report preparation and record maintenance

Required qualifications

• Bachelor's degree in nursing preferred; graduate from a nationally accredited nursing program required
• Currently holds an unencumbered registered nurse (RN) license with the State Board of Nursing
• Knowledge of oncology is preferred
• Ability to maintain required department-specific competencies and certifications