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Full Time Optum Utilization Review Jobs in Indiana

Pinnacle Treatment Centers

Counselor

Martinsville, IN · On-site

Counselor Full-Time | Martinsville, IN We offer competitive salaries, a comprehensive benefits ... Maintain an assigned caseload, including case management, utilization review updates, treatment ...

Hickory Recovery

Call Center

Indianapolis, IN · On-site

$19/hr

Director of Admissions   Job Type : Full-Time, 2nd Shift (3 -11pm), One weekend shift required ... and Utilization Review. Extensive contact via phone and email are daily expectations in a fast ...

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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

RN Case Manager - Sign-on Bonus - $7,500

Interim HealthCare

Greenwood, IN • On-site

Full-time

This job post has expired today. Applications are no longer accepted.

Job description

Description


Full-Time / Sign-on Bonus - $7,500 - Northside of Greenwood
Your Nursing Career Deserves More Than a Routine.
Are you an RN who loves bedside nursing and making a lasting impact behind the scenes? We're hiring an RN Case Manager in Greenwood to join our amazing team at Interim HealthCare!

What we offer our Registered Nurse Case Managers (RNCM):


Competitive pay, benefits, and incentives.


Truly flexible scheduling - a dedication to work/life balance - Full-time


Daily Pay option available


No Overtime Required


1:1 patient care


Working at Interim HealthCare means a career unlike any other. With integrity at the center of all we do, we know that when we support you and your community, you'll change lives every day.


As a Registered Nurse Case Manager (RNCM), you will:


Conduct In Person patient interviews and comprehensive physical assessments.


Oversee the implementation and ongoing assessment of the patient's plan of care through the management of home health aides, LPNs, RNs, and other caregivers.


Communicate patient conditions and collaborate with appropriate providers to deliver care when patient needs evolve.


Provide education to patients and families on proper home health care procedures. Ie. Wound care, IV administration, medication management.


Work to decrease readmissions by promoting preventative care and ensuring continuity of care.


To qualify as a Registered Nurse Case Manager (RNCM) with us, you will need:


Licensure: Current unrestricted license to practice as a Registered Nurse (RN) in the state associated with this position


Current CPR/AED/BLS/First Aid certification


Reliable transportation to/from care sites and/or work locations.


One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred.


OASIS experience preferred.


Practical trach and/or ventilator experience preferred, not required.


At Interim HealthCare, we know that being our best is non-negotiable - that's why we treat your family like our own. We take a patient-centric approach to address each individual's mind, body, and spirit, our caregivers work tirelessly to help their patients and families find peace. From our unmatched referral response times to our focus on quality improvement, the most beautifully complicated time of your life is our life's work.


We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.

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