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Director Optum Utilization Review Jobs in Indiana

Beacon Health System

W/Alt UM Nurse (BHS)

Granger, IN · On-site

... the Emergency Department, Direct Admissions and surgical patients. The pre-admission phase ... Critical utilization management functions during the admission phase include admission review for ...

Beacon Health System

W/Alt UM Nurse (BHS)

Granger, IN · On-site

... the Emergency Department, Direct Admissions and surgical patients. The pre-admission phase ... Critical utilization management functions during the admission phase include admission review for ...

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Director Optum Utilization Review information

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

AspectDirector Optum Utilization ReviewUtilization Review Manager
CertificationsTypically requires certifications like CCM or URAC accreditationOften requires similar certifications, may vary by employer
Work EnvironmentWorks within Optum or similar healthcare organizations, overseeing utilization review processesManages utilization review teams, often within healthcare providers or insurance companies
ResponsibilitiesStrategic oversight of utilization review policies, compliance, and team leadershipSupervises daily review operations, staff management, and process improvements

The main difference is that the Director Optum Utilization Review typically holds a higher strategic leadership role within Optum, focusing on policy and compliance, while the Utilization Review Manager manages daily operations and staff. Both roles require similar credentials but differ in scope and level of responsibility.

What are the most commonly searched types of Optum Utilization Review jobs in Indiana? The most popular types of Optum Utilization Review jobs in Indiana are:
What are popular job titles related to Director Optum Utilization Review jobs in Indiana? For Director Optum Utilization Review jobs in Indiana, the most frequently searched job titles are:
What job categories do people searching Director Optum Utilization Review jobs in Indiana look for? The top searched job categories for Director Optum Utilization Review jobs in Indiana are:
What cities in Indiana are hiring for Director Optum Utilization Review jobs? Cities in Indiana with the most Director Optum Utilization Review job openings:
Director Optum Utilization Review jobs near you
Infographic showing various Director Optum Utilization Review job openings in Indiana as of June 2026, with employment types broken down into 1% As Needed, 97% Full Time, 1% Temporary, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Utilization Review RN

Healthcare Support Staffing

Indianapolis, IN

$30 - $34/hr

Full-time

Medical, Dental, Vision

Re-posted 11 days ago

Job description

Company Description

Anthem, Inc. is working to transform health care with trusted and caring solutions. Our health plan companies deliver quality products and services that give their members access to the care they need. With more than 73 million people served by its affiliated companies including nearly 40 million enrolled in its family of health plans, Anthem is one of the nation's leading health benefits companies.

One in nine Americans receives coverage for their medical care through Anthem's affiliated plans.
We offer a broad range of medical and specialty products.

Job Description

These candidates will be working in the continued stay review department. They will be looking at emerging urgent inpatient admissions for medical necessity. Strong computer skills, positive attitude, and ability to hit high production goals is what the manager is looking for here. Expected to review 20 cases a day with a 95% accuracy rate.

Responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources

MAJOR JOB DUTIES AND RESPONSIBILITIES

  • Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources.
  • Applies clinical knowledge to work with facilities and providers for care coordination.
  • Works with medical directors in interpreting appropriateness of care and accurate claims payment.
  • May also manage appeals for services denied.
  • Conducts precertification, inpatient, retrospective, out of network and
    appropriateness of treatment setting reviews to ensure compliance
    with applicable criteria, medical policy, and member eligibility, benefits,
    and contracts.
  • Ensures member access to medical necessary, quality
    healthcare in a cost effective setting according to contract.
  • Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.
  • Collaborates with providers to assess member's needs for early identification of and proactive planning for discharge planning.
  • Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications.
  • Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
Qualifications


  • Must have clear and active RN license in the state of IN
  • 2 years of experience in a acute care clinical environment (The candidate should have a strong ER/Critical Care/Med-Surgical clinical background. )
  • Knowledge of Millman or Interqual criteria
  • Must have prior UM experience
  • Needs to be flexible to change
  • Experience with reviewing medical records
  • Proficient with computers and using MS applications
  • Strong written and verbal communication skills
Additional Information

Advantages of this Opportunity:


Competitive salary, negotiable based on relevant experience
Benefits offered, Medical, Dental, and Vision
Fun and positive work environment
$30 - $34 per hour
Monday - Thursday 8am-5pm EST Friday - 9am - 6pm EST Occasional Saturday rotation (8am-Noon) EST


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About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

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