20 Best jobs in Harrisburg, 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
Payroll And Benefits Specialist
C & B Equipment —Sioux Falls, SD
Maintain records and reporting for multi-state tax accounts, and other documentation required by federal, state, and provider rules, regulations, and policies.
Estimated: $45.8K - $58K a year
Technical Communicator
C & B Equipment —Sioux Falls, SD
Valid driver’s license and a safe driving record. Maintains up to date technical knowledge of relevant OEM engine, drivetrain, hydraulics, and electrical…
Estimated: $42.8K - $54.1K a year
Warehouse Worker (11:30 PM - 5:00 AM)
UPS —Sioux Falls, SD
The ability to lift up to 70 lbs. Reliability, responsibility, and a really good pair of work shoes. Excellent weekly pay, every Friday.
$21 an hour
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John Deere Internet Sales Representative
C & B Equipment —Sioux Falls, SD
Valid driver’s license and a safe driving record. Bachelor's Degree in Ag Business or related field preferred. High school diploma or equivalent required.
Estimated: $61.3K - $77.6K a year
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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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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3d
RN - Outpatient Care 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…
$32 - $48 an hour
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1d
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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3d
Day-time Barista
Scooters Coffee —Sioux Falls, SD
Franchisees are independent business owners who set own terms of employment, including wage and benefit programs, which can vary between franchisees.
Estimated: $21.6K - $27.2K a year
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15h
Warehouse Cleaner 4 Day Work Week
ABM of South Dakota —Sioux Falls, SD
Duties will include cleaning and maintaining restrooms, break rooms, carpets and hard surface floors by vacuuming, sweeping, and mopping floors.
Up to $17.50 an hour
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Athletic Trainer DME Coordinator - Orthopedics
Avera Medical Group Orthopedics Sioux Falls —Sioux Falls, SD
CSCS certification through the NSCA preferred. You Belong at Avera: Competitive pay, front-loaded PTO and options for free health insurance, sign-on bonuses,…
$21.50 - $32.50 an hour
Evening 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
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
1d
Member Engagement Manager
Girl Scouts Dakota Horizons —Sioux Falls, SD
Valid, current driver’s license required. Collaborate with Service Unit and Member Experience team to develop and execute annual Service Unit assessments in an…
$44,000 - $46,000 a year
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RN - Infusion Center - Part Time 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…
$32 - $48 an hour
Quick Apply
1d
21+ Errand Runners/ Drivers Needed!
Gopher, Inc —Sioux Falls, SD
Sign Up, complete you profile and start seeing jobs immediately. Gophers receive their pay immediately after completed a job. 21+ for age-restricted deliveries.
$20 - $40 an hour
Quick Apply
Front Desk Receptionist/Patient Coordinator
Serenity Esthetics Spa —Sioux Falls, SD
Answer phone calls, schedule appointments, and manage the front desk area. Previous experience working in a spa or similar front desk role is preferred.
From $15 an hour
Quick Apply
5d
Housekeeper - Part-time
Avera McKennan Hospital —Sioux Falls, SD
You Belong at Avera: Competitive pay, front-loaded PTO and options for free health insurance, various shifts to fit your lifestyle and opportunities for career…
$17.00 - $20.50 an hour
3d

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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 Harrisburg, SD

Referral Specialist, RN, Health Plan

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

Payroll And Benefits Specialist

Technical Communicator

Warehouse Worker (11:30 PM - 5:00 AM)

John Deere Internet Sales Representative

Patient Safety Analyst, RN - Sioux Falls

RN - VDM Radiology - Edith Breast Center - FT

RN - Outpatient Care Center - FT Days

RN - Pulmonary Clinic - Full Time

Day-time Barista

Warehouse Cleaner 4 Day Work Week

Athletic Trainer DME Coordinator - Orthopedics

Evening Package Handler

Day Package Handler

Member Engagement Manager

RN - Infusion Center - Part Time Days

21+ Errand Runners/ Drivers Needed!

Front Desk Receptionist/Patient Coordinator

Housekeeper - Part-time

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