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Full Time Optum Utilization Review Jobs in Indiana

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 ...

Ourhrconnect

This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:

Ourhrconnect

This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:

Ourhrconnect

This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:

Ourhrconnect

This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:

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All JobsOptum Utilization Review JobsFull Time Optum Utilization Review JobsFull Time Optum Utilization Review Jobs in Indiana

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

Psychologist

Jane Pauley Community Health Center, Inc.

Anderson, IN

Full-time

Re-posted 23 days ago

Jane Pauley Community Health Center rating

7.5

Company rating: 7.5 out of 10

Based on 8 frontline employees who took The Breakroom Quiz

Job description

We're seeking a Psychologist that delivers comprehensive behavioral health services within a team-based primary care environment. This role provides direct patient care, clinical leadership, and care coordination while supporting quality, compliance, and continuous improvement across the practice site. The Provider works collaboratively with medical, behavioral health, and operational teams to ensure safe, effective, and accessible care for all patients.
Job Summary
Job Responsibilities (include but are not limited to):

Clinical & Patient Care

  • Provide behavioral health services to patients, including assessment, diagnosis, and treatment.
  • Maintain full-time, on-site clinical coverage as assigned.
  • Provide clinical direction and oversight to team members delivering direct patient care.
  • Coordinate care across inpatient and outpatient settings when appropriate.
  • Participate in patient satisfaction and quality improvement initiatives.

Care Coordination & Referrals

  • Utilize JPCHC and Community Health Network inpatient and outpatient facilities.
  • Refer patients to appropriate providers and services in alignment with organizational standards, patient preference, insurance requirements, and clinical judgment.
  • Collaborate with referring providers to ensure continuity of care.

Quality & Compliance

  • Support the development and implementation of:
    • Quality assurance programs
    • Utilization review
    • Clinical pathways
    • Performance improvement initiatives
  • Ensure care delivery meets federal, state, payer, and accreditation standards.

Education & Team Development

  • Support the education and training of staff in the delivery of behavioral health services.
  • Provide consultation and guidance to clinical and support staff.

Administrative & Leadership Responsibilities

  • Ensure compliance with all licensing, regulatory, and accreditation requirements at the practice site.
  • Support documentation, billing, and payer compliance (including Medicare and Medicaid).
  • Supervise clinical services delivered by non-provider team members under your direction.
  • Assist in recruitment, onboarding, and orientation of new Providers.
  • Participate in utilization review, quality monitoring, and medical staff activities.
  • Provide input into operational and staffing decisions to support safe, effective care delivery.

Required Skills and Qualifications

  • Must hold an active Indiana license as a Psychologist, including Health Service Provider in Psychology (HSPP) designation or be eligible to obtain within an approved timeframe.
  • Doctor of Psychology (PsyD) or Doctor of Philosophy (PhD) in Clinical Psychology, Counseling Psychology, or a related behavioral health field required.
  • Must maintain all required state licensure, DEA (if applicable), and professional certifications in good standing throughout employment.

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