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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 ...

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Full Time Optum Utilization Review information

What are some common challenges faced by full time Optum utilization review, 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?

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?

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

Utilization Review Coordinator

Neuropsychiatric Hospitals

Indianapolis, IN • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 10 days ago

Job description

About UsHealing Body and Mind.

NeuroPsychiatric Hospitals is a national leader in behavioral healthcare, specializing in patients with acute psychiatric and complex medical needs. Our hospitals use an interdisciplinary, multi-specialty approach that delivers high-quality, patient-centered care when it's needed most.

With locations in Indiana, Michigan, Texas, and Arizona, we're expanding access to our unique model of care across the United States. Join us and be part of a team dedicated to making a lasting difference in the lives of patients and families every day

Overview

NeuroPsychiatric Hospitals of Indianapolis is looking for a Utilization Review Coordinator to coordinate patients' services across the continuum of care by promoting effective utilization, monitoring health resources and elaborating with multidisciplinary teams.

Benefits of joining NPH

  • Competitive pay rates
  • Medical, Dental, and Vision Insurance
  • NPH 401(k) plan with up to 4% Company match
  • Employee Assistance Program (EAP) Programs
  • Generous PTO and Time Off Policy
  • Special tuition offers through Capella University
  • Work/life balance with great professional growth opportunities
  • Employee Discounts through LifeMart
Responsibilities
  • Filing documents as needed.
  • Initial Precertification with payors.
  • Concurrent Clinical review with payors.
  • Document in the electronic system daily in real time.
  • Admission audit.
  • Ensures that CON's/RON's and CMS certifications are completed by provider.
  • Consistently demonstrates professionalism with all internal and external customers as evidenced by positive customer and peer Communicates effectively with all staff and patients as evidenced by the establishment and maintenance of productive working relationships.
  • Maintains knowledge of current trends and developments in the field by reading appropriate books; journals and other literature and attending related seminars or conferences.
  • Maintains a professional approach with Assures protection and privacy of health information as attained through written, electronic or oral disclosures.
  • Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
  • Seeks guidance and remains knowledgeable of, and complies with, all applicable federal and state laws, as well as hospital polices that apply.
  • Complies with hospital expectations regarding ethical behavior and standards of conduct.
  • Complies with federal and hospital requirements in the areas of protected health information and patient information.
  • Reconsiderations, assists with appeals as needed, arrange peer to peer level reviews, and report the outcomes to the VP of Care Management and Team.
  • Provides education to nursing staff. ;eadership team, and providers regarding documentation.
  • Actively works with the business office regarding resolution of appeals/denials and retrospective reviews. 
Qualifications

Education: Bachelor's in Behavioral Health, Social Work, Counseling, Nursing or Psychology required. Master's degree preferred.

Experience: Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 years of case management experience, including discharge planning in a hospital setting required.

Licensure: Certified Case Manager (CCM) or Accredited Case Manager (ACM) preferred. Basic Life Support (BLS) and Handle with Care (HWC) obtained during orientation, if applicable.

Skills: Must have strong knowledge of medications and demonstrate exceptional time management, data entry, and communication skills. Must be detail oriented.#INDEEDLOW

Employment Type: FULL_TIME

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