South Dakota Licensed Utilization Specialist

Job Summary

A company is looking for a Utilization Management Specialist.

Key Responsibilities

• Conduct level of care medical necessity reviews and manage utilization management activities
• Collaborate with healthcare team members to ensure appropriate resource utilization and compliance with regulations
• Assist in monitoring resource utilization, risk management, and quality of care while preparing reports and maintaining records

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
• Maintains required department-specific competencies and certifications