Secondary Review Nurse - Indiana

UnitedHealth Group; Indiana; Remote; USD 75.000 - 95.000; Vollzeit

Benefits dieser Stelle

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase and 401k

Zusammenfassung

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.

Qualifikationen

• 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.

Aufgaben

• 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.

Kenntnisse

Clinical Experience

LTSS Experience

Medicaid/Medicare Experience

Ausbildung

RN license Indiana

Jobbeschreibung

About This Role

The Secondary Review Nurse plays a critical role in evaluating clinical requests for Home and Community-Based Services (HCBS), ensuring that care is medically necessary, cost-effective, and compliant with state regulations.

Highlights

• Location: Indianapolis, IN
• Schedule: Full Time, Day shift
• Residency: Must reside in Indiana
• Work Style: Remote

What You'll Do

• Participate in secondary reviews for HCBS services 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

Requirements

Education:

• Current, unrestricted RN license for Indiana

Experience:

• 3+ years of clinical experience in a 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

Licenses & Certifications:

• Current RN License in Indiana required

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase and 401k contribution

About UnitedHealth Group

UnitedHealth Group is a leading healthcare provider committed to delivering exceptional patient care. They focus on simplifying the health care experience and creating healthier communities while addressing health disparities and improving health outcomes.