Remote RN: HCBS & Medicaid Utilization Review

UnitedHealth Group; Indiana; Remote; USD 75,000 - 95,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase and 401k

Job summary

UnitedHealth Group is seeking a Secondary Review Nurse in Indianapolis, IN for full-time day shift. The role focuses on evaluating HCBS/Medicaid services for medical necessity, matching care with regulations, and ensuring cost-effective, quality care.

You will review authorizations, apply clinical judgment, and collaborate with care managers to maintain continuity of care. Indiana-resident RNs with LTSS and Medicaid/Medicare experience are encouraged to apply.

Qualifications

• Current, unrestricted RN license for Indiana.
• 3+ years of clinical experience in hospital, acute care, home health/hospice, direct care, or case management.
• 2+ years of experience with completing functional assessments for LTSS services.
• 2+ years of Medicaid, Medicare, or Managed Care experience with Long-Term Services and Supports.

Responsibilities

• Participate in secondary reviews for HCBS and Medicaid services.
• Review and process prior authorization requests for LTSS and HCBS services.
• Apply clinical judgment and decision support tools to determine medical necessity and appropriateness of services.
• Collaborate with care managers, physicians, and other stakeholders to ensure continuity of care.
• Monitor utilization patterns and identify opportunities for improved care coordination and cost containment.
• Document all clinical decisions and communications in accordance with regulatory and organizational standards.
• Support quality improvement initiatives and participate in developing education and training for staff.
• Identify potential quality of care concerns and elevate issues as needed.
• Stay current with established guidelines and regulatory requirements.

Skills

Clinical Experience

LTSS Experience

Medicaid/Medicare Experience

Education

RN license Indiana

Job description

UnitedHealth Group is seeking a Secondary Review Nurse in Indianapolis, IN for full-time day shift. The role focuses on evaluating HCBS/Medicaid services for medical necessity, matching care with regulations, and ensuring cost-effective, quality care.

You will review authorizations, apply clinical judgment, and collaborate with care managers to maintain continuity of care. Indiana-resident RNs with LTSS and Medicaid/Medicare experience are encouraged to apply.