Indiana Licensed Secondary Review Nurse

Job Summary

Evaluating clinical requests for Home and Community-Based Services (HCBS), the part-time Indiana Licensed Secondary Review Nurse will work remotely to ensure care is medically necessary, cost-effective, and compliant with state regulations.

Key responsibilities:

• Participate in secondary reviews for HCBS and Medicaid services
• Review and process prior authorization requests for LTSS and HCBS services
• Collaborate with care managers and physicians to ensure continuity of care

Required qualifications:

• Current, unrestricted RN license for Indiana
• 3+ years of clinical experience in a relevant healthcare setting
• 2+ years of experience with functional assessments for LTSS services
• 2+ years of Medicaid, Medicare, or Managed Care experience
• Intermediate knowledge of LTSS eligibility and service allocation