20 Best jobs in Sioux Falls, SD (Hiring Now!)

Referral Specialist, RN, Health Plan
Sanford Health —Sioux Falls, SD
Currently holds an unencumbered registered nurse (RN) license with the State Board of Nursing. Ensure services comply with professional standards, national and…
$27.50 - $44.00 an hour
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2d
RN - Registered Nurse - Hospital Outpatient Scheduling - Patient Appointment Center - Part Time
Sanford Health —Sioux Falls, SD
Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in…
$32 - $48 an hour
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3d
RN - Edith Breast Center - FT Days
Sanford Health —Sioux Falls, SD
Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in…
$26.00 - $38.50 an hour
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1d
RN - VDM Radiology - Edith Breast Center - FT
Sanford Health —Sioux Falls, SD
Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in…
$26.00 - $38.50 an hour
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4d
Part- Time Counter Sales Representative
Hog Slat, Inc. —Rock Rapids, IA
Must poses a valid driver license. Must be willing and able to obtain fork lift certification and use a fork lift regularly.
Estimated: $31K - $39.2K a year
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Patient Safety Analyst, RN - Sioux Falls
Sanford Health —Sioux Falls, SD
For Long term care they must maintain a certification/licensure as required by profession state(s) of practice and/or possess multi-state licensure privileges…
$29.00 - $46.50 an hour
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2d
Day Package Handler
UPS of South Dakota —Sioux Falls, SD
The ability to lift up to 70 lbs. Excellent weekly pay, every Friday. Up to $25,000 in tuition assistance. Medical, dental and vision after waiting period.
$21 an hour
2d
Armed Security Guard - Sioux falls and Rapid City South Dakota
Kerberos International, Inc. —Sioux Falls, SD
In addition, enforce all facility access control policies and process visitors as directed by verifying visitor’s identification, contacting agency sponsors or…
$20.85 an hour
Maintenance
My Place Hotels —Sioux Falls, SD
Contribute to the hotel's commitment to the highest quality of guest service. Perform and maintain records for maintenance and preventative maintenance to all…
$16 - $20 an hour
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6d
Construction Laborer
American Playground & Recreation —Tea, SD
Must have VALID LICENSE! American Playground Company is one of the largest Playground contractors in Sioux Falls with nineteen operations throughout the…
$29 - $32 an hour
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11d
Delivery Driver Part Time
Team Allied Distribution —Sioux Falls, SD
Must have a current drivers license, 3 years driving experience with an acceptable motor vehicle record (MVR) per our Insurance company standards.
$18 an hour
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Customer Service Representative
Marvs Body Shop —Sioux Falls, SD
Ultimately, you will help us produce high customer satisfaction scores through your ability to listen and empathize with customers in need of support.
$18 - $20 an hour
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2d
Trust Officer
Way Trust —Sioux Falls, SD
Monitor cash and facilitate cash movement. Assist with continued development, implementation and refinement of trust company policies and procedures.
Estimated: $73.9K - $93.6K a year
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RN - Pulmonary Clinic - Full Time
Sanford Health —Sioux Falls, SD
Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in…
$26.00 - $38.50 an hour
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4d
Early Morning part time
All In One Cleaning, LLC —Sioux Falls, SD
All in one cleaning is looking for fast pace hardworking people to join our crew! positions available great pay additional hours available. Fri.-Sat.6:30 AM…
From $20 an hour
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10d
Cafeteria Help Wanted - FULL TIME DAY & NIGHT SHIFT OPENINGS!
United Vending and Food service —Sioux Falls, SD
We have both day shift as well as evening shift positions available and all positions are FULL TIME! We offer a competitive salary and a great benefits package…
Estimated: $24.5K - $31K a year
Quick Apply
Home Medical Equipment Clinician II - Full-Time
Avera@Home Home Medical Equipment Sioux Falls —Sioux Falls, SD
This position requires a valid driver’s license and that the employee is insurable by the Avera Health automobile liability insurance carrier.
$20.00 - $24.75 an hour
5d
Host
CRAVE American Kitchen & Sushi Bar —Sioux Falls, SD
This role will require fast paced service done with a smile and a high level of communication with guests, co workers, Managers and Chefs.
$16 - $20 an hour
Quick Apply
5h
Host
MacKenzie River Pizza Grill & Pub —Sioux Falls, SD
*Off-shift discount for you and 3 friends (Or family members!). *Referral program* - Bring your bestie to work.
$12 - $14 an hour
Quick Apply
Assembler
Open Door Mfg LLC —Sioux Falls, SD
Use hand tools and power tools to complete assembly tasks. Proficient in using hand tools and power tools. Strong mechanical knowledge and aptitude.
$20 - $22 an hour
Quick Apply
5d

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Referral Specialist, RN, Health Plan

Sanford Health - Sioux Falls, SD

Quick Apply

Job Details

Full-time $27.50 - $44.00 an hour 2 days ago

Benefits

Health insurance
Dental insurance
401(k)
Vision insurance
Opportunities for advancement
Life insurance

Qualifications

Nursing
RN License
ICD coding
3 years
Medical administrative support
Bachelor's degree
Case management
Utilization management
CPT coding
Medical terminology
Communication skills

Full Job Description

Careers With Purpose

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.

Facility: GSS SD Sf Ctr

Location: Sioux Falls, SD

Address: 401 W 2nd St, Sioux Falls, SD 57104, USA

Shift: 8 Hours - Day Shifts

Job Schedule: Full time

Weekly Hours: 40. 00

Salary Range: $27.50 - $44.00

Department Details

Fun, fast paced work, remote work

Job Summary

Communicate with providers and/or members regarding management of out-of-network exception requests. Provide care coordination for designated Health Plan members that includes managing and directing members to appropriate resources, services and programs. Work directly with referring providers and participating provider specialty groups in coordinating care.

Responsible for managing the authorization process for participating plan members ensuring that all services are performed within assigned evidence-based guidelines and performed at the appropriate level of care in a timely, cost-effective and efficient manner. The collection and interpretation of clinical information is necessary to initiate and execute authorizations. Essential functions must occur simultaneously; therefore, the specialist must be able to appropriately handle and prioritize various daily tasks. Must be able to collaborate with other health plan departments as needed for medical coverage, case agreement negotiation and policy application. Obtain and maintain appropriate documentation concerning services in accordance to regulatory and accreditation guidelines and timelines. Provide information to providers and members in regards to authorization and/or denial of services. Ability to review, analyze and summarize reports and have effective oral and written communication skills. Understanding of medical terminology, international classification of diseases and current procedural terminology (CPT) codes. Understanding and administration of medical, administrative and management principles and policy necessary to operate within a managed care organization.

Ability to determine appropriate action for referring cases that do not meet departmental standards and require additional secondary review and/or escalation as needed.

May also be actively involved in collaborating with members of the healthcare team to promote medically necessary resource utilization and achievement of fiscal outcomes when appropriate. Collaborates with physicians and other clinical professionals as needed to assist in documentation improvement practices for effective and appropriate services. Dynamic and tactful interpersonal skills, particularly in relating to physicians and other health care professionals. Educates members of the healthcare team regarding trends, external regulations and internal policies that effect resource utilization and potentially, prior authorization.

Assists the department in monitoring the utilization of resources, risk management and quality of care for patients in accordance with guidelines and criteria. Assist in report preparation, correspondence, and maintenance of appropriate records. Ensure services comply with professional standards, national and local coverage determinations (NCD/LCD), centers for Medicare and Medicaid services (CMS), as well as state and federal regulatory requirements. Maintain working knowledge of payer standards for UM functions for authorization requirements.

May assist with additional special projects related to work, upcoming initiatives, new organizational goals and audits when delegated. Considered a resource to all team members and acts as a point of contact for guidance, training, and assisting with questions. Demonstrate flexibility and adaptability where scheduling may fluctuate due to communication needs within interdepartmental and clinical units are required.

Possesses strong clinical knowledge and skills. Collaborates with team members both internally and externally to ensure care is coordinated and appropriate based on evidence based medicine. Ability to work independently or as a member of a team. Ability to multitask and work with little direction. Works primarily day hours.

Administer and prioritize daily tasks, and apply Sanford Health Plan policies and regulatory requirements consistently and use good judgment as when to seek out guidance. Possess broad understanding of products and benefits and a demonstrated understanding of regulatory requirements and timeframes.

Assist with coordination of activities related to insurance pre-certification/authorization. Provide counseling to members or their representative regarding pre-service requirements and instructions.

Qualifications

Bachelor's degree in nursing preferred. Graduate from a nationally accredited nursing program required, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA).

Will consider applicant with significant background in case management and/or utilization management experience. Minimum of three years nursing experience is required.

Currently holds an unencumbered registered nurse (RN) license with the State Board of Nursing. Obtains and subsequently maintains required department specific competencies and certifications.

Benefits

Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits .

Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .

Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.

Req Number: R-0189887

Job Function: Health Plan

Featured: No

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jobs in Sioux Falls, SD

Referral Specialist, RN, Health Plan

RN - Registered Nurse - Hospital Outpatient Scheduling - Patient Appointment Center - Part Time

RN - Edith Breast Center - FT Days

RN - VDM Radiology - Edith Breast Center - FT

Part- Time Counter Sales Representative

Patient Safety Analyst, RN - Sioux Falls

Day Package Handler

Armed Security Guard - Sioux falls and Rapid City South Dakota

Maintenance

Construction Laborer

Delivery Driver Part Time

Customer Service Representative

Trust Officer

RN - Pulmonary Clinic - Full Time

Early Morning part time

Cafeteria Help Wanted - FULL TIME DAY & NIGHT SHIFT OPENINGS!

Home Medical Equipment Clinician II - Full-Time

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