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Utilization Management Coordinator (Home-Based) - Prior Authorization

February 16, 2026

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. Work Shift:Day (United States of America)Scheduled Weekly Hours:40Salary Range: $21.50 - $28.00Union Position: NoDepartment DetailsOpportunity to work remotely.SummaryMonitors the utilization of resources, risk management and quality of care for patients in accordance to established guidelines and criteria for designated setting and status. Collection of clinical information necessary to initiate commercial payor authorization.Job DescriptionObtain and maintain appropriate documentation concerning services in accordance to reimbursement agency guidelines. Consult with interdepartmental departments and staff to assure all relevant information regarding patient status and diagnosis are accurately reported. Provide information via multiple sources of technology applications to insurance companies and contracted vendors to assure authorization for patients. May participate in providing assistance in financial aid and/or counseling if applicable. Accurately recognizes coding principle diagnosis and principle procedures including complicating/comorbid diagnoses for accurate diagnosis-related group (DRG) assignment during hospitalization. Monitors patient hospitalization to ensure prospective payment limit is not exceeded without due notice to the attending physician. May also need to notify physician and patient of authorization denials. Inputs collected data into computer system for insurance communication, DRG grouping, data abstraction for monitoring and evaluation, and when applicable, Medicare National and Local Coverage Determinations (NCD/LCD), and Joint Commission (TJC) required functions and credentialing. Assists medical records coding personnel as needed to correctly identify diagnoses and procedures, and obtains physician documentation as needed. Monitors patient hospitalization to ascertain medical necessity and appropriateness. Assists with retrospective review of specified charts as required. Ability to interact on an interpersonal basis with both providers and nursing staff. Demonstrates proficiency with computers, Microsoft applications, and additional designated technology within the department. Will perform multiple administrative duties including accurate record keeping and electronic data management when needed. Ability to work with growth and development needs of pediatric to geriatric populations.QualificationsAppropriate education level required in accordance with licensure. Seven years of relevant experience, superior communication and interpersonal skills. Minimum one year healthcare or clinical experience required. Specific background or experience in healthcare reimbursement, insurance industry, and/or authorization experience would be critical to the success in this role and preferred. Currently holds an unencumbered Licensed Practical Nurse (LPN) license with State Nursing board and/or possess multi-state licensure privileges, or Registered Health Information Technician (RHIT) required. Additionally, pharmacy technician or coding certifications also acceptable, i.e. Certified Coding Specialist (CCS), Certified Coding Specialist - Physician based (CCS-P), Certified Professional Coder (CPC), Certified Professional Coder - Hospital (CPC-H), Certified Outpatient Coder (COC), or Certified Ambulance Coder (CAC). Obtains and subsequently maintains required department specific competencies and certifications.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.

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...