Work From Home Work From Home Work From Home, Indiana 46544 The Utilization Review Coordinator performs admission screening for patients in a bed for medical necessity, and reviews for appropriateness of setting and utilization. WHO WE ARE With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve. WHAT YOU CAN EXPECT - Schedule: Monday - Friday, 8am - 4:30pm EST - Perform concurrent reviews for appropriateness of utilization to optimize clinical and financial outcomes. - Communicate with physicians, patients, members of the Healthcare team, Coordinated Business Office staff, Denial Management staff, and third-party payors to justify the admission or continued stay. - Notify appropriate staff members of any admission, service, length of stay, lack of medical necessity criteria, as well as denials/appeals and issuing of letters to patients. - Provide Physician, Patient, Family, Staff and Student education. - Act as a resource person for the case management department regarding payer rules, regulations, policies and procedures, and utilization issues. - Perform admission necessity screening using criteria as established by the various federal, state and private sector programs. QUALIFICATIONS - Associate degree in nursing/patient care required - Bachelor's Degree in nursing/patient care preferred - Registered Nurse (RN - Indiana licensure) required - 3 years of nursing/patient care experience required - 2 years of Utilization or Case Management experience preferred TRAVEL IS REQUIRED: Never or Rarely JOB RANGE: Utilization Review Coordinator $56971.20-$84749.60 INCENTIVE: Not Applicable EQUAL OPPORTUNITY EMPLOYER It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law. Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights. Franciscan Alliance is committed to equal employment opportunity. Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.

The job profile for this position is Staff Pharmacist, which is a Band 3 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. This is a remote position. Candidates must reside and be licensed in one of the following states: Arizona, Indiana, Florida, Ohio or Tennessee and preferably reside within an hour of our local sites. The start date for this position is 4/27/26. Training period: 8 to 12 weeks. During the training period, the hours will either be Monday through Friday 8am - 4:30pm ET or 9am - 5:30 pm ET Once training is completed, schedules will be assigned per your placement. **Candidates must be open to being placed in either the offline or consult position and be able to commit to the training and future schedules for both positions. POSITION SUMMARY The Staff Pharmacist interprets physicians’ prescriptions, contacts doctors or other prescribers and/or patients to verify information on prescriptions and expedite processing of order. The Staff Pharmacist may track order status and outstanding issues as well as consult with patients regarding the use of medications and potential drug interactions. This individual may take calls from customers regarding lost orders or dispensing errors, maintain daily production, quality and service levels, vary work priorities and activities to accommodate business needs. The Staff Pharmacist may also train less experienced pharmacists. ESSENTIAL FUNCTIONS Consult with patients regarding the use of medications and potential drug interactions. Contact physicians for new and/or transfer authorization. Collaborate with physicians to convert prescriptions to generic or preferred drugs whenever possible. Interpret physicians’ or prescribers’ prescriptions. Contact doctors and/or patients to verify information on prescriptions such as drug strength, prescription sig., and drug name in order to expedite processing of orders. Provide oversight and quality assurance to pharmacy technicians. Verify and confirm validity of controlled substances. Verify prescription information entered in the system by data entry or order entry. Back up other pharmacists as needed, perform additional duties as assigned by management, or train less experienced pharmacists. QUALIFICATIONS Bachelor's degree in Pharmacy required, PharmD preferred Current active resident pharmacist license in good standing. Advanced problem-solving skills and the ability to work collaboratively with other departments to resolve issues. Good oral and written communication skills. Ability to read and interpret prescriptions. Strong focus on customer service, quality and accuracy. Ability to manage timelines and meet tight client deadlines. Ability to adapt in a changing environment. Ability to work a flexible schedule for peak volume times. Confidential, unpublished property of The Cigna Group. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2026 The Cigna Group If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an hourly rate of 54 - 91 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Anticipated End Date: 2026-04-04 Position Title: Medical Management Specialist I Job Description: Medical Management Specialist I Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. The ideal candidate will be located near one of the following Pulsepoints: Norfolk-VA, Richmond-VA, Roanoke-VA, Indianapolis-IN, Atlanta-GA, Tampa-FL, Lake Mary-FL or Miami-FL. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Schedule: This position will work an 8-hour shift from 8:00 am - 5:00 pm (EST) or 7:00 am - 4:00 pm (CST), Monday through Friday. Additional hours, including weekends or holidays, may be required based on operational needs. The Medical Management Specialist I is responsible for providing non-clinical support to the Medical Management and/or Operations areas. How you will make an impact: Primary duties may include, but are not limited to: - Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review). - Provides information regarding network providers or general program information when requested. - Regularly interacts with providers regarding authorization related inquiries. - May assist with complex cases. - May act as liaison between Medical Management and/or Operations and internal departments. - Maintains and updates tracking databases. - Prepares reports and documents all actions. - Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information. Minimum Requirements: - Requires a H.S. diploma or equivalent and a minimum of 1 year experience or any combination of education and experience which would provide an equivalent background. Preferred Skills, Capabilities, and Experiences: - Understanding of managed care or Medicaid/Medicare strongly preferred. - Previous experience in healthcare industry and customer service is a plus. - One year of experience working with authorizations is desired. - Previous experience working with LTSS members or Medicaid is strongly preferred. - Knowledge of AUMI/ACMP is highly preferred. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. Job Level: Non-Management Non-Exempt Workshift: 1st Shift (United States of America) Job Family: MED > Medical Ops & Support (Non-Licensed) Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

Become a part of our caring community The Registered Dietitian 2 designs meal plans that alter and regulate patients' nutrition based upon medical condition and individual nutritional needs. This is a remote position. Core hours are Mon-Fri, between 8am-6pm. The Registered Dietitian 2 utilizes scientific principles and methods in the study of nutrition and dietetics, applying these results to influence the wider environment affecting food intake and eating behavior. This position will focus on the Medicare population with chronic conditions such diabetes, COPD, heart failure, etc. Use your skills to make an impact Required Qualifications - Registered Dietitian (RD) or Registered Dietitian Nutritionist (RDN) with the commission on Dietetic Registration - Master's degree in Dietetics or Nutrition - Minimum 3 years of experience in dietetics and/or health coaching - Licensed in state of residence and possess knowledge of the legal responsibilities including all state and federal laws and regulations governing nutrition practice - Proficient in Microsoft Office applications including Word, Excel and Outlook Preferred Qualifications - Bilingual in English & Spanish (passing a language proficiency will be required) - Remote/Work at Home experience - Certified Diabetic Educator - Experience in the health insurance - Experience with Medicare population - Experience working with Special Needs Plan members - Additional state licensure Work-At-Home Requirements To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: ​ - At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested - Satellite, cellular and microwave connection can be used only if approved by leadership - Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense - Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $59,300 - $80,900 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 04-16-2026 About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. ​ Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.