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Medical Eligibility/Prior Authorization Nurse Consultant

Date Posted:  Oct 18, 2019
Requisition ID:  13746
Location: 

Indianapolis, US, 46204

Work for Indiana

Grow your career with the State of Indiana! With more than 50 executive branch agencies, the State of Indiana is a diverse workforce offering employees stimulating and challenging projects across a broad scope of career opportunities. As a State of Indiana employee, you impact the well-being of Indiana’s communities every day.

 

Indiana State Department of Health

The Indiana State Department of Health’s mission is to promote and provide essential public health services for a healthier and safer state.

 

This position traditionally starts at an annual salary of $36,894 . 

Nurse Consultant

This role serves as a Nurse Consultant, determines medical eligibility of applicants and provides prior authorization of services to families of participants with serious, chronic medical conditions to obtain medical treatment related to the participant's medical condition. This position provides consultation to local agencies and interprets Children's Special Health Care Services (CSHCS) program policies to participants, families, providers and the public.

A day in the life

The essential functions of this role are as follows:

  • Evaluates and ensures that all medical records or requests for authorization of payment and specialty care linkages are in compliance with CSHCS rules and policies are directly related to the eligible medical condition(s).
  • Recognizes and updates possible medical diagnoses needs for program participants.
  • Explains program in detail to program participants and families regarding requirements, e.g., Indiana resident, notification of changes in address, income, insurance coverage, service coverage or termination and eligibility-related criteria to providers.
  • Applies problem-solving skills by recommending medical solutions or giving needed referrals to appropriate agencies.
  • Assist participants in the transition from CSHCS program due to age or non-eligibility to another program, agency or to any available services.
  • Completes timely re-determination of medical eligibility for the CSHCS.
  • Attends appeals hearings as needed when a participant is denied an authorization of a service or medical eligibility.
  • Obtains and makes changes of insurance information of participants.

 

The job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time.

What we're looking for
  • Commitment to the public health mission of protecting the health, safety, rights and privacy of program participants and their families.
  • Specialized knowledge of nursing principles, techniques and medical needs as applied to the population served, primarily children with chronic medical conditions.
  • Considerable knowledge of and the ability to review and analyze medical records and documents.
  • Considerable knowledge of program rules and policies.
  • Specialized knowledge of rehabilitation including therapy and durable medical equipment.
  • Working knowledge of insurance and Medicaid/Hoosier Healthwise.
  • Ability to communicate verbally and in writing with individuals and in group situations.
  • Ability to be flexible and maintain composure in stressful situations.
  • Ability to manage time and complete assignments without constant supervision.
  • Understanding of and ability to work as a member of a team.
  • Working knowledge of computers.

 

Benefits of Employment with the State of Indiana:

The State of Indiana offers a comprehensive benefit package for full-time employees which includes:

  • Four (4) medical plan options (including RX coverage) and vision/dental coverages
  • Wellness program (offers eligibility into a discounted medical plan)
  • Health savings account (includes bi-weekly state contribution)
  • Deferred compensation account (similar to 401k plan) with employer match
  • Two (2) fully-funded pension plan options
  • Group life insurance
  • Employee assistance program that allows for covered behavioral health visits
  • Paid vacation, personal and sick time off
  • Competitive leave policies covering a variety of employee needs
  • 12 company paid holidays, 14 on election years
  • Qualified employer for the Public Service Loan Forgiveness Program
  • New Parent Leave

 

Equal Employment Opportunity:

The State of Indiana is an Equal Opportunity Employer

Current Employee? Click here to apply.


Nearest Major Market: Indianapolis