At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come b…
Skills: Clinical judgment, Utilization management, Case management, Medicaid, Medicare
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Customer Operations Specialist - Auto Part Counter Sales
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Entry level$3M raised
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Entry level$3.7B raised
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The Secondary Review Nurse evaluates clinical requests for Home and Community-Based Services to ensure medical necessity and cost-effectiveness. They collaborate with care managers and physicians to monitor utilization patterns and document clinical decisions in compliance with regulatory standards.
Requirements
Candidates must hold a current, unrestricted RN license for Indiana and possess at least 3 years of clinical experience. Additionally, 2 years of experience in Medicaid, Medicare, or Managed Care and LTSS functional assessments is required.
Full job description
At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The Secondary Review Nurse plays a critical role in evaluating clinical requests for Home and Community-Based Services (HCBS). This position ensures that care provided is medically necessary, cost-effective, and tailored to the individual needs of each member, while remaining compliant with state regulations.
If you reside within the state of Indiana, you will enjoy the flexibility to work remotely as you take on some tough challenges.
Primary Responsibilities:
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 and alignment with the members’ service plan
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, including instances of over/or underutilization of services and escalate these issues as needed
Stay current with established guidelines and regulatory requirements
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
Current, unrestricted RN license for Indiana
3+ years of clinical experience in a hospital, acute care, home health / hospice, direct care or case management and the ability to quickly identify needs and issues
2+ years of experience with completing functional assessments for LTSS services
2+ years of Medicaid, Medicare, or Managed Care experience and with Long-Term Services and Supports
Intermediate level of knowledge of LTSS experience determining eligibility and appropriate allocation of services
Intermediate level of computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications
Preferred Qualifications:
Pre-authorization experience
Utilization Management experience
Case Management experience
Knowledge of state and federal guidelines
Home health or hospice
Proven problem-solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29 - $52 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
UnitedHealth Group is a health care and well-being company with a mission to help people live healthier lives and help make the health system work better for everyone.
We are 340,000 colleagues in two distinct and complementary businesses working to help build a modern, high-performing health system through improved access, affordability, outcomes and experiences.
Optum delivers care aided by technology and data, empowering people, partners and providers with the guidance and tools they need to achieve better health. UnitedHealthcare offers a full range of health benefits, enabling affordable coverage, simplifying the health care experience and delivering access to high-quality care.
We work with governments, employers, partners and providers to care for 147 million people and share a vision of a value-based system of care that provides compassionate and equitable care.
At UnitedHealth Group, our mission calls us, our values guide us and our diverse culture connects us as we seek to improve care for the consumers we are privileged to serve and their communities.
Click below to search careers or join our social communities:
• Search & apply for careers at careers.unitedhealthgroup.com/
• Follow us on Twitter at twitter.com/UnitedHealthGrp
• Follow and like us on Facebook at facebook.com/unitedhealthgroup
• Follow us on Instagram at instagram.com/unitedhealthgroup
More about UnitedHealth Group can be found at unitedhealthgroup.com/
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Based on 386 listings with disclosed salaries, most administrative jobs in Indiana pay between $45k–$85k per year. Individual offers vary with seniority, company size, and specialization.
How many Administrative jobs are open in Indiana right now?
There are currently 5,445 open administrative positions in Indiana listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Administrative roles in Indiana?
Companies currently hiring include Indiana University Health, Indiana State Park Inns, Ascension, Franciscan Alliance, Inc., Ivy Tech Community College Indianapolis, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Administrative jobs in Indiana?
Yes — 525 of the 5445 open administrative positions offer remote or hybrid work (188 remote, 337 hybrid).
How do I apply for Administrative jobs in Indiana?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.