Secondary Review reputed company - Indiana

<p class="MsoNormal"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to reputed company care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, reputed company and reputed company. reputed company to reputed company a difference? Join us to start <strong>Caring. Connecting. Growing together.</strong></reputed company></p><p class="MsoNormal"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">The <strong>Secondary Review reputed company</strong> 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 reputed company member, while remaining compliant with state regulations.</reputed company></p><p class="MsoNormal"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">If you reputed company reputed company the state of <strong>Indiana</strong>, you will enjoy the flexibility to work remotely * as you take on some tough challenges.</reputed company></p><p class="MsoNormal"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;"><strong>Primary Responsibilities:</strong></reputed company></p><ul style="margin-top:0in;" type="disc"><li class="MsoNormal" style="mso-list:l0 level1 lfo1;tab-stops:list .5in;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">Participate in secondary reviews for HCBS services and reputed company services</reputed company></li><li class="MsoNormal" style="mso-list:l0 level1 lfo1;tab-stops:list .5in;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">Review and process prior authorization requests for LTSS and HCBS services</reputed company></li><li class="MsoNormal" style="mso-list:l0 level1 lfo1;tab-stops:list .5in;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">Apply clinical judgment and decision support tools to determine medical necessity and appropriateness of services</reputed company></li><li class="MsoNormal" style="mso-list:l0 level1 lfo1;tab-stops:list .5in;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">Collaborate with care managers, physicians, and other stakeholders to ensure continuity of care and alignment with the member’s service plan</reputed company></li><li class="MsoNormal" style="mso-list:l0 level1 lfo1;tab-stops:list .5in;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">Monitor utilization patterns and identify opportunities for improved care coordination and cost containment</reputed company></li><li class="MsoNormal" style="mso-list:l0 level1 lfo1;tab-stops:list .5in;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">Document reputed company clinical reputed company and communications in accordance with regulatory and organizational standards</reputed company></li><li class="MsoNormal" style="mso-list:l0 level1 lfo1;tab-stops:list .5in;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">Support reputed company improvement initiatives and participate in developing education and training for staff</reputed company></li><li class="MsoNormal" style="mso-list:l0 level1 lfo1;tab-stops:list .5in;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">Identify potential reputed company of care concerns, including instances of over/or underutilization of services and escalate these issues as needed</reputed company></li><li class="MsoNormal" style="mso-list:l0 level1 lfo1;tab-stops:list .5in;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">Stay reputed company with established guidelines and regulatory requirements</reputed company></li></ul><p><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in.</reputed company></p><br><br><p class="MsoNormal"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;"><strong>Required Qualifications:</strong></reputed company></p><ul style="margin-top:0in;" type="disc"><li class="MsoNormal" style="mso-list:l0 level1 lfo1;tab-stops:list .5in;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">reputed company, unrestricted RN license in the reputed company</reputed company></li><li class="MsoNormal" style="mso-list:l0 level1 lfo1;tab-stops:list .5in;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">3+ years of clinical experience in a hospital, acute care, home health / hospice, reputed company care or case management, reputed company to quickly identify needs and issues</reputed company></li><li class="MsoNormal" style="mso-list:l0 level1 lfo1;tab-stops:list .5in;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">2+ years of experience with completing functional assessments for LTSS services</reputed company></li><li class="MsoNormal" style="mso-list:l0 level1 lfo1;tab-stops:list .5in;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">2+ years of reputed company, Medicare, or Managed Care experience and, Long Term Services and Supports</reputed company></li><li class="MsoNormal" style="mso-list:l0 level1 lfo1;tab-stops:list .5in;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">Intermediate level of knowledge of LTSS experience determining eligibility and appropriate allocation of services</reputed company></li><li class="MsoNormal" style="mso-list:l0 level1 lfo1;tab-stops:list .5in;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">Intermediate level of computer/typing proficiency to reputed company/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications</reputed company></li></ul><p class="MsoNormal"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;"><strong>Preferred Qualifications:</strong></reputed company></p><ul style="margin-top:0in;" type="disc"><li class="MsoNormal" style="mso-list:l1 level1 lfo2;tab-stops:list .5in;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">reputed company-authorization experience</reputed company></li><li class="MsoNormal" style="mso-list:l1 level1 lfo2;tab-stops:list .5in;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">Utilization Management experience</reputed company></li><li class="MsoNormal" style="mso-list:l1 level1 lfo2;tab-stops:list .5in;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">Case Management experience</reputed company></li><li class="MsoNormal" style="mso-list:l1 level1 lfo2;tab-stops:list .5in;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">Knowledge of state and federal guidelines</reputed company></li><li class="MsoNormal" style="mso-list:l1 level1 lfo2;tab-stops:list .5in;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">Home health or hospice</reputed company></li><li class="MsoNormal" style="mso-list:l1 level1 lfo2;tab-stops:list .5in;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">Proven problem-solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of reputed company</reputed company></li></ul><p style="-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-reputed company:start;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">*reputed company Telecommuters will be required to adhere to reputed company’s Telecommuter Policy.</reputed company></p><p style="-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-reputed company:start;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">    </reputed company></p><p style="-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-reputed company:start;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;"><reputed company style="background-reputed company:inherit;reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;"><reputed company class="TextRun SCXO172345993 BCX0 NormalTextRun" style="-webkit-tap-reputed company-reputed company:transparent;-webkit-text-stroke-width:0px;-webkit-user-drag:none;font-style:normal;font-variant-caps:normal;font-variant-ligatures:none !important;font-weight:400;letter-spacing:normal;line-height:20.7px;margin:0px;orphans:2;padding:0px;text-reputed company:left;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;user-select:text;white-reputed company:normal;widows:2;word-spacing:0px;" data-contrast="auto" xml:lang="EN-US" lang="EN-US">Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll reputed company a far-reaching choice of benefits and incentives. The salary for this role will </reputed company><reputed company class="TextRun SCXO172345993 BCX0 NormalTextRun" style="-webkit-tap-reputed company-reputed company:transparent;-webkit-text-stroke-width:0px;-webkit-user-drag:none;font-style:normal;font-variant-caps:normal;font-variant-ligatures:none !important;font-weight:normal;letter-spacing:normal;line-height:20.7px;margin:0px;orphans:2;padding:0px;text-reputed company:left;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;user-select:text;white-reputed company:normal;widows:2;word-spacing:0px;" data-contrast="auto" xml:lang="EN-US" lang="EN-US">reputed company</reputed company><reputed company class="TextRun SCXO172345993 BCX0 NormalTextRun" style="-webkit-tap-reputed company-reputed company:transparent;-webkit-text-stroke-width:0px;-webkit-user-drag:none;font-style:normal;font-variant-caps:normal;font-variant-ligatures:none !important;letter-spacing:normal;line-height:20.7px;margin:0px;orphans:2;padding:0px;text-reputed company:left;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;user-select:text;white-reputed company:normal;widows:2;word-spacing:0px;" data-contrast="auto" xml:lang="EN-US" lang="EN-US"><strong> </strong></reputed company><reputed company class="TextRun SCXO172345993 BCX0 NormalTextRun" style="-webkit-tap-reputed company-reputed company:transparent;-webkit-text-stroke-width:0px;-webkit-user-drag:none;font-style:normal;font-variant-caps:normal;font-variant-ligatures:none !important;font-weight:400;letter-spacing:normal;line-height:20.7px;margin:0px;orphans:2;padding:0px;text-reputed company:left;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;user-select:text;white-reputed company:normal;widows:2;word-spacing:0px;" data-contrast="auto" xml:lang="EN-US" lang="EN-US">from $60,200 to $107,400 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable.</reputed company></reputed company><reputed company style="background-reputed company:rgb(255,255,255);reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;"><reputed company class="EOP SCXO172345993 BCX0" style="-webkit-tap-reputed company-reputed company:transparent;-webkit-text-stroke-width:0px;-webkit-user-drag:none;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;line-height:20.7px;margin:0px;orphans:2;padding:0px;text-reputed company:left;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;user-select:text;white-reputed company:normal;widows:2;word-spacing:0px;"> </reputed company></reputed company></p><p style="-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-reputed company:start;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">    </reputed company></p><p style="-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-reputed company:center;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;"><i><reputed company style="line-height:10.7px;">At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location, and income–deserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company, and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission.</reputed company></i></reputed company></p><p style="-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-reputed company:center;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">    </reputed company></p><p style="-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-reputed company:center;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">    </reputed company></p><p style="-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-reputed company:center;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;"><i>reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.</i></reputed company></p><p style="-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-reputed company:center;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;"><i>    </i></reputed company></p><p style="-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-reputed company:center;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;"><i>reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.</i></reputed company></p><p style="-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-reputed company:center;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;"><i>    </i></reputed company></p><p style="-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-reputed company:center;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;"><i>   </i></reputed company></p><p style="-webkit-text-stroke-width:0px;background-reputed company:rgb(255, 255, 255);reputed company:rgb(0, 0, 0);font-family:Tahoma;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-reputed company:start;text-decoration-reputed company:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-reputed company:none;white-reputed company:normal;widows:2;word-spacing:0px;"><reputed company style="reputed company:black;font-family:Tahoma, Geneva, reputed company;font-size:10px;">#RPO #GREEN</reputed company></p>