Registered Nurse Clinical in Sioux Falls, SD
Job Description
A company is looking for a Clinical Nurse.
Key Responsibilities :
Partner with health plan utilization review nurses to validate and improve AI-driven prior authorization workflows
Review and structure medical policies to enable AI-powered automation of utilization review decisions
Manage small-scale projects, including organizing digitization initiatives and tracking timelines
Qualifications :
Registered Nurse (RN) with an active license
3+ years of experience in utilization management, prior authorization, or related clinical roles
Strong understanding of payer policies and medical necessity criteria
Working knowledge of medical coding systems (ICD-10, CPT, HCPCS)
Demonstrated project management skills to organize complex workflows
Job Details
Employment Type
Full-time
Required License
RN (Registered Nurse)
Work Setting
Clinic
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