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Director Optum Health Utilization Review Jobs in Indiana

Ascension

Registered Nurse Utilization Review

Carmel, IN · On-site +1

$50 - $52/hr

Assess and coordinate discharge planning needs with healthcare team members. * May prepare statistical analysis and utilization review reports as necessary. * Oversee and coordinate compliance to ...

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Director Optum Health Utilization Review information

What is the difference between Director Optum Health Utilization Review vs Utilization Review Manager?

AspectDirector Optum Health Utilization ReviewUtilization Review Manager
CertificationsTypically requires RN, CPC, or other healthcare-related certificationsOften requires RN or healthcare management certifications
Work EnvironmentCorporate healthcare setting, primarily in insurance or health services companiesHealthcare facilities or insurance companies managing patient care reviews
ResponsibilitiesOversees utilization review processes, policy development, and team managementManages daily review operations, staff supervision, and compliance

The main difference is that the Director Optum Health Utilization Review typically holds a higher leadership role with strategic responsibilities, while the Utilization Review Manager focuses more on daily operations and team management within the utilization review process.

What does a director of Optum Health Utilization Review do?

A director of Optum Health Utilization Review oversees the review process to evaluate the necessity, appropriateness, and efficiency of healthcare services. They manage teams of reviewers, ensure compliance with policies and regulations, and use data analysis to improve utilization management strategies. Strong leadership, knowledge of healthcare policies, and experience with utilization review tools are essential for this role.

What are the most commonly searched types of Optum Health Utilization Review jobs in Indiana?

The most popular types of Optum Health Utilization Review jobs in Indiana are:

What cities in Indiana are hiring for Director Optum Health Utilization Review jobs?

Cities in Indiana with the most Director Optum Health Utilization Review job openings:

Director Optum Health Utilization Review jobs near you

Specialist, Utilization Review

Lafayette, IN • On-site

Lifepoint Health
Health Care and Social Assistance • 10K+ employees

5.9

Company rating: 5.9 out of 10

Based on 272 frontline employees who took The Breakroom Quiz

765th of 895 rated healthcare providers

People enjoy working here

Recommended by students

Recommended by parents

Learn more about Lifepoint Healthexternal

Part-time

Medical, Dental, Vision, Retirement, PTO

Posted 27 days ago

Job description

Your experience matters 

At Sycamore Springs, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In your role, you'll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve.

 What we offer

Fundamental to providing great care is supporting and rewarding our team. In addition to your base compensation, this position also offers:  

  • Health (Medical, Dental, Vision) and 401K Benefits for full-time employees
  • Competitive Paid Time Off 
  • Employee Assistance Program - mental, physical, and financial wellness assistance
  • Tuition Reimbursement/Assistance for qualified applicants
  • And much more...

About Us 

People are our passion and purpose. Sycamore Springs is a 48 bed hospital located in Layfette, IN and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestone-your experience matters

How you'll contribute 

Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays. UR analyzes patient records to determine legitimacy of admission, treatment, and length of stay and interfaces with managed care organizations, external reviewers and other payers. UR advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric or emotional disorders to managed care providers for necessary treatment. UR contacts external case managers/managed care organizations for certification of insurance benefits throughout the patient's stay and assists the treatment team in understanding the insurance company's requirements for continued stay and discharge planning. 

 Essential Functions:

  • Displays knowledge of clinical criteria, managed care requirements for inpatient and outpatient authorization and advocates on behalf of the patient to secure coverage for needed services
  • Completes pre and re-certifications for inpatient and outpatient services. Reports appropriate denial, and authorization information to designated resource.
  • Actively communicates with interdisciplinary team to acquire pertinent information and give updates on authorizations.
  • Participate in treatment teams to ensure staff have knowledge of coverage and to collect information for communication with agencies.
  • Works with DON to ensure documentation requirements are met.
  • Ensure appeals are completed thoroughly and on a timely basis.
  • Interface with managed care organizations, external reviews, and other payers.
  • Communicate with physicians to schedule peer to peer reviews.
  • Accurately report denials.

Qualifications and requirements 

Bachelor's Degree
Previous utilization review experience in a psychiatric healthcare facility preferred.

EEOC Statement:

Sycamore Springs is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status or any other basis protected by applicable federal, state or local law.

Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.We employ and provide care to people from all walks of life. We are committed to promoting healing, providing hope, preserving dignity and producing value with an inclusive workforce in which diversity is leveraged, respected, and reflective of the patients, family members, customers and team members we serve.
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About LifePoint Health

Sourced by ZipRecruiter

Lifepoint Health serves patients, clinicians, communities and partners across the healthcare continuum. Our diversified healthcare delivery network extends from coast to coast, consisting of community hospitals, rehabilitation and behavioral health hospitals, and additional sites of care.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Brentwood, TN, US

Year founded

1999

Social media

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What LifePoint Health employees say

Pay

Benefits

Hours and flexibility

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