Secondary Review Nurse

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.

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

• 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

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

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

United Health 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.