20 Best project specialist jobs (Hiring Now!)

Referral Specialist, RN, Health Plan
Sanford Health —South Dakota
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
Quick Apply
4h
Quality Assurance Specialist
Rauch North America, Inc. —Waddell, AZ
Organization, planning and performance of internal audits to evaluate the implemented management systems and the implementation of customer requirements…
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Lease Up Specialist - Pine at Wildroot
ROUNDHOUSE COMMUNITIES LLC —Missoula, MT
Must maintain a valid driver’s license, clean driving record and current auto insurance is required. Complies with all company policies, applicable health, and…
$18 - $19 an hour
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Emergency Response Specialist Tier 1
Lewis Environmental —New Cumberland, PA
The ERS is responsible for partnering with the Field Supervisor/Response Coordinator/Project Managers to manage field personnel and equipment to efficiently…
$20 - $24 an hour
Closing Specialist
Veterans United Home Loans —Columbia, MO
Quality Control: Perform quality control analysis to maintain high standards. Effectively Communicating: Coordinate with loan teams and third-party vendors,…
$19.23 an hour
Supply Chain Procurement Specialist
Houlotte Bil-Jax —Archbold, OH
A minimum two-year degree in Supply Chain Management or related technical field along with 3-5 years of experience in supply chain operations or 5+ years of…
From $65,000 a year
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T&D Specialist (Sr, Principal) Salt Lake City, Utah #111507
PacifiCorp —Salt Lake City, UT
A minimum of 15 years of industry experience as a substation journeyman, relay technician, communications technician or T&D Specialist including experience…
Construction Project Specialist
King County Housing Authority —Tukwila, WA
Must possess a valid driver's license and own or have access to a vehicle to regularly travel between work sites or have an alternative reliable mode of…
$34.01 - $41.65 an hour
6d
Proofreader
Implico Communications Inc. —Dallas, TX
Ability to manage multiple projects simultaneously, demonstrating flexibility and problem-solving. This specialized training includes learning to write benefits…
$22 an hour
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14h
Creative Project Management Specialist - Remote
Hilton Grand Vacations —Orlando, FL
Proactively and consistently conceive of, define, and develop process improvements to increase efficiency and productivity across the Branding & Creative…
Estimated: $55K - $69.6K a year
1d
Learning Specialist
Winston Preparatory School —San Rafael, CA
Confer with parents, administrators, testing specialists, social workers, and other outside professionals to develop individualized goals and objectives…
$85,000 - $95,000 a year
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Project Control Specialist
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Support the development and implementation of risk mitigation plans. Support the management and execution of IA projects, contributing to the development and…
Estimated: $47.6K - $60.3K a year
1d
Payroll Accountant
MORryde —Elkhart, IN
Bachelor’s degree in Accounting, Human Resources, or related field is preferred. Timely, accurate preparation and processing of weekly payroll for approximately…
Estimated: $44.7K - $56.6K a year
10d
Communication Specialist
FocusKPI Inc. —San Francisco, CA
Build and manage social media strategy for executives, maintaining a calendar of social posts. Pitch in with writing and content needs across the communications…
$35 - $42 an hour
Quick Apply
1d
FEMA Public Assistance Specialist
Thompson Consulting Services —United States
Valid driver's license and safe driving history. May be required to work outside when conducting project site inspections or other field work.
$35 - $45 an hour
Quick Apply
2d
Project Specialist - Church HR
HR Ministry Solutions —Remote
The HR Project Specialist is a detail oriented and driven person with an innate ability to see God’s fingerprints in HR for churches and has a passion to…
$20 - $22 an hour
Quick Apply
1d
Construction Specialist
Palo Alto Alvarado Concepts —Greenwood Village, CO
Operate and maintain various hand tools and power tools necessary for drywall installation and finishing, such as tape measures, saws, drills, and sanders.
Estimated: $48.2K - $61.1K a year
Quick Apply
4d
Shelby White & Leon Levy Digital Archives and Collections Specialist
The National September 11 Memorial & Museum —New York, NY
A graduate degree in library and information science, digital archiving, or a related field. Identifies and procures tools, equipment, and software necessary…
Up to $85,000 a year
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Multimedia Specialist
FreedomCare —Remote
Formal education degree in Multimedia Design, Film Production, Communications, or related field. Conceptualize, write, and develop engaging video/audio scripts,…
$65,000 - $70,000 a year
Quick Apply
Certification Specialist
American Osteopathic Association —Remote
Deals with the administrative and clerical duties of the position as needed to support the Vice President, Associate Vice President, and Certification Manager’s…
$58,000 - $63,500 a year
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3d

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Referral Specialist, RN, Health Plan

Sanford Health - South Dakota

Quick Apply

Job Details

Full-time $27.50 - $44.00 an hour 4 hours 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: Remote SD (Central Time)

Location: City - Remote SD, SD

Address:
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

Quick Apply

project specialist jobs

Referral Specialist, RN, Health Plan

Quality Assurance Specialist

Lease Up Specialist - Pine at Wildroot

Emergency Response Specialist Tier 1

Closing Specialist

Supply Chain Procurement Specialist

T&D Specialist (Sr, Principal) Salt Lake City, Utah #111507

Construction Project Specialist

Proofreader

Creative Project Management Specialist - Remote

Learning Specialist

Project Control Specialist

Payroll Accountant

Communication Specialist

FEMA Public Assistance Specialist

Project Specialist - Church HR

Construction Specialist

Shelby White & Leon Levy Digital Archives and Collections Specialist

Multimedia Specialist

Certification Specialist

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