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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in utilization management and case management, with a strong focus on medical necessity reviews and clinical judgment. Proficient in maintaining clinical information and educating providers on medical management processes while adhering to HIPAA regulations.
Highest-signal resume keywords
RN License in IndianaUtilization Management ExperienceCase Management ExperienceProficient with MS OfficeIndependent Decision-Making
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical Necessity ReviewLevel-of-Care ReviewClinical JudgmentUtilization ManagementCase ManagementDischarge PlanningHome Health ExperienceRehab Experience
Soft Skills
Team CollaborationIndependent Work
Tools & Technologies
Medical Management SystemsMS Office
Certifications & Qualifications
Active RN License
Industry Keywords
PHIHIPAAClinical InformationGuidelines and Policies
About the role
Key responsibilities & impact- Review prior authorization requests for appropriate care and setting
- Follow guidelines and policies when approving services or forwarding requests to the appropriate stakeholder
- Complete medical necessity and level-of-care reviews using clinical judgment
- Refer cases to team members for review based on findings
- Educate providers on utilization and medical management processes
- Enter and maintain relevant clinical information in medical management systems
- Interpret department, segment, and organizational strategy and operating objectives
- Make independent decisions regarding work methods in ambiguous situations
- Follow established guidelines and procedures
Requirements
What you’ll need- 2+ years of RN experience
- Active RN license in the state of Indiana
- Ability to be licensed in multiple states without restrictions
- Previous experience in utilization management, case management, discharge planning and/or home health or rehab
- Proficient with MS Office products including Word, Excel and Outlook
- Ability to work independently under general instructions and with a team
- Minimum home internet download speed of 25 Mbps
- Minimum home internet upload speed of 10 Mbps
- Dedicated workspace without ongoing interruptions to protect member PHI / HIPAA information
Benefits
Comp & perks- Bonus incentive plan based on company and/or individual performance
- Medical benefits
- Dental benefits
- Vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company holidays
- Personal holidays
- Paid parental leave
- Paid caregiver leave
- Short-term disability
- Long-term disability
- Life insurance
- Other wellness and healthcare opportunities
- Remote work arrangement
- Company-provided training or meeting travel may be required