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Director, Utilization Management, Health Plan
Director, Utilization Management, Health Plan-August 2024
Sioux Falls
Aug 9, 2026
About Director, Utilization Management, Health Plan

  Create Your Career With Us!

  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: Cherapa Place Building

  Location: Sioux Falls, SD

  Address: 300 N Cherapa Pl, Sioux Falls, SD 57103, USA

  Shift: Day

  Job Schedule: Full time

  Weekly Hours: 40.00

  Job Summary

  Responsible for providing clinical administrative leadership and expertise to the Sanford Health Plan utilization department and practice operations. Possesses major responsibility for implementing the vision and mission, plan and standards of the organization and the utilization management department. Contributes to the strategic planning process, day-to-day operations and attainment of goals of the organization. Responsible for the partnering with the medical management leadership teams in communication for the contextual environment in which clinical services are delivered across the organization. Responsible for providing professional, technical and clinical expertise.

  Actively participates in tasks force, committees, board meetings, etc. to assist with the overall organizational goals and strategic initiatives. Knowledgeable of governing bodies, budgeting, accreditation and contracts. Reviews and consults on final strategic plans in collaboration with leadership. Collaborates with other health systems as necessary. Ability to carry out strategies and tasks and support the mission and goals of the organization. Develops trusting relationships with personnel, clinical professionals, other leadership, and multi-disciplinary departments in a professional attitude. Understanding of current and potential team capabilities and ability to clarify performance targets and objectives to drive project and process improvement strategies. Knowledge of human resources and personnel management processes; ability to lead, motivate, evaluate, and reward personnel at the work place.

  Qualifications

  Bachelor's degree in nursing required. Master'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).

  Four years of clinical nursing experience required. Two years experience in utilization management preferred. Leadership/management experience preferred. Experience in medical necessity review preferred.

  Currently holds an unencumbered registered nurse (RN) license with the State Board of Nursing and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state. Obtains and subsequently maintains required department specific competencies and certifications. Certification is encouraged and may be required depending on specialty or service area.

  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 [email protected] .

  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-0172964

  Job Function: Health Plan

  Featured: No

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