This position
requires a current Indiana Nurse License.
This is a
MONDAY - FRIDAY, FULL-TIME DAYS position!
POSITION SUMMARY:
The Utilization Management/Prior Authorization Nurse is responsible for completing medical necessity reviews in compliance with MDwise Hoosier Alliance. This includes reviewing inpatient hospital admissions/continued stays and inpatient/outpatient elective procedures requiring prior authorization. Requests information, assesses and appropriately directs/facilitates discharge planning. Consistently applies medical benefit policy and medical management guidelines to authorize services. Identifies and refers requests for services to the appropriate Medical Director when guidelines are not met.
KEY COMPETENCIES:
- Excellent oral and written communication skills.
- Attention to detail.
- Ability to define problems, collect information and recommend solutions.
- Knowledge of computer equipment.
- Excellent collaboration skills.
- Ability to plan and organize.
- Ability to promote member/ member family autonomy.
- Ability to advocate for member/ member family needs.
- Excellent decision-making and follow-up skills.
- Self-directed.
- Knowledge of community resources as well as plan benefits information.
- Ability to analyze clinical outcomes.
MDwise Hoosier Alliance offers an outstanding total compensation package including:
- Friendly work environment
- Casual dress
- Competitive salary
- Pension Plan
- 401(k) Plan
- Health, Dental, Vision & Life Insurance
- Educational Assistance
- Flexible Spending Accounts
- Paid Vacation
- Paid Time Off
- Paid Holidays