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Full Time Optum Utilization Review Jobs in Indiana

TEEMA Group

RN Care Manager

Evansville, IN · On-site

$85K - $95K/yr

RN Care Manager - NO Weekends | M-F Schedule | Evansville, IN 📍 Evansville, IN | Full-Time | Day ... Perform utilization review (UR) and payer communication * Support hospital goals: reduce LOS ...

Deaconess

Clinical Denial Analyst (RN)

Evansville, IN · On-site

$28.71 - $40.19/hr

Minimum of two (2) years performing utilization review, charge audit, case management or similar ... HRS Hours: Full-time, 40 hours/week Equal Opportunity Employer This employer is required to notify ...

Elevance Health

Utilization Management Rep I

Indianapolis, IN · On-site

$15.25 - $20.75/hr

This role enables associates to work virtually full-time, except for required in-person training ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...

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Full Time Optum Utilization Review information

What are some common challenges faced by Full Time Optum Utilization Review nurses, and how can they be managed?

Full Time Optum Utilization Review nurses often encounter challenges such as managing high caseloads, staying updated with frequently changing insurance and regulatory guidelines, and effectively communicating with both healthcare providers and patients. Time management and strong organizational skills are crucial for balancing documentation with timely case reviews. Collaborating closely with multidisciplinary teams and utilizing technology tools provided by Optum can help streamline workflows and ensure compliance with policies, ultimately leading to more effective patient care coordination.

What are the key skills and qualifications needed to thrive as a Full Time Optum Utilization Review Nurse, and why are they important?

To thrive as a Full Time Optum Utilization Review Nurse, you need a current RN license, strong clinical assessment skills, and a solid understanding of medical necessity criteria and healthcare regulations. Familiarity with utilization management software, electronic health records (EHRs), and platforms like InterQual or MCG is typically required. Excellent communication, critical thinking, and attention to detail are vital soft skills for effectively coordinating care and collaborating with providers. These abilities ensure efficient, compliant care management, cost containment, and optimal patient outcomes within the healthcare system.

What is a Full Time Optum Utilization Review position?

A Full Time Optum Utilization Review position involves working for Optum, a healthcare services company, to review patient medical records and determine the medical necessity and appropriateness of healthcare services. Utilization Review professionals collaborate with healthcare providers, insurers, and patients to ensure that care provided is efficient, cost-effective, and aligns with established guidelines. The role typically requires knowledge of clinical standards, strong communication skills, and the ability to interpret medical documentation. Full-time positions often come with benefits and require standard weekly work hours.

What is the difference between Full Time Optum Utilization Review vs Full Time Medical Reviewer?

AspectFull Time Optum Utilization ReviewFull Time Medical Reviewer
CertificationsTypically requires medical licenses and utilization review certificationsRequires medical licenses, often with additional certifications in utilization review
Work EnvironmentInsurance companies, healthcare organizations, remote or office-basedHospitals, clinics, insurance companies, often in clinical settings
Employer & Industry UsagePrimarily in health insurance and managed careIn healthcare facilities and insurance sectors

Full Time Optum Utilization Review professionals focus on evaluating medical necessity for insurance claims, often working remotely or in insurance settings. Full Time Medical Reviewers also assess medical necessity but may work directly within clinical environments. Both roles require medical credentials and involve reviewing patient records, but their work settings and employer types differ slightly.

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:
Full Time Optum Utilization Review jobs near you

Specialist, Utilization Review

Lifepoint Health

Newburgh, IN • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 8 days ago

LifePoint Health rating

6.0

Company rating: 6.0 out of 10

Based on 268 frontline employees who took The Breakroom Quiz

749th of 890 rated healthcare providers

Job description

Your experience matters 

At Brentwood 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. Brentwood Springs is a 48 bed hospital located in Newburgh, 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. 

Qualifications and requirements 

  • Education: Bachelor's degree required. Master's degree preferred.
  • Experience: Previous utilization review experience in a psychiatric healthcare facility preferred.
  • License: Current unencumbered clinical license strongly preferred.
  • Additional Requirements: CPR certification and Crisis Prevention Training (CPI) preferred.

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.

EEOC Statement:

Brentwood 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.

What LifePoint Health employees say

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Benefits

Hours and flexibility

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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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