ZipRecruiter

Log In

2

Full Time Optum Utilization Review Jobs in Virginia

Maximus

Consultant - Medical (Case Reviewer 2)

VA · On-site +1

... States Working time Full-time Description & Requirements Maximus is currently hiring for a ... hire). - Medical/Utilization Review experience. - Medicare Set-Aside Arrangement experience.

Carilion Clinic

RN Case Manager

Roanoke, VA · On-site

Employment Status: Full time Shift: Day/Evening (United States of America) Facility: 1906 Belleview ... Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ...

Carilion Clinic

RN Case Manager - Weekends

Roanoke, VA · On-site

Employment Status: Full time Shift: Day/Evening (United States of America) Facility: 1906 Belleview ... Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ...

next page

Showing results 1-20

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

Full Time Optum Utilization Review information

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 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 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 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 Virginia?

The most popular types of Optum Utilization Review jobs in Virginia are:

What cities in Virginia are hiring for Full Time Optum Utilization Review jobs?

Cities in Virginia with the most Full Time Optum Utilization Review job openings:

Full Time Optum Utilization Review jobs near you

Clinical Coordinator - Utilization Review

Hampton-Newport News Community Services Board

Hampton, VA • On-site

$62K - $66K/yr

Full-time

Dental, Vision, Life, Retirement

Re-posted 8 days ago

Job description

Clinical Coordinator - Utilization ReviewAnnual Salary: $62,406 - $66,000Work Schedule: Monday - Friday 8:30 am - 5:00 pmThe Hampton-Newport News Community Services Board (CSB) is seeking a Clinical Coordinator - Utilization Review to join the Region 5 Reinvestment Initiative. This full-time position plays an important role in ensuring individuals receive timely, appropriate, and effective behavioral health services while supporting regional efforts to improve access to care and coordinate treatment placements.The Clinical Coordinator - Utilization Review conducts utilization reviews of acute and intermediate levels of care, evaluates medical necessity and appropriateness of services, and manages behavioral health bed utilization on a daily basis. This position works closely with hospitals, treatment facilities, CSB staff, and regional partners to support timely movement to the most appropriate level of care.Minimum QualificationsTo qualify for this position, candidates must have:Master's degree in Human Services or a related field.Three (3) years of experience in behavioral health, including utilization management.Key ResponsibilitiesConduct utilization reviews of acute and intermediate levels of care to assess medical necessity, appropriateness of treatment, and continued stay criteria.Manage and monitor acute care bed availability and placements to support timely and appropriate transitions in care.Conduct face-to-face assessments and gather information regarding an individual's treatment needs, progress, and current level of functioning.Review treatment progress and outcomes and make recommendations regarding the most appropriate level of care.Coordinate communication among hospitals, facilities, CSB staff, and regional partners regarding admissions, continued stays, discharges, and placements.Provide guidance and recommendations related to acute, sub-acute, crisis stabilization, and community-based services.Monitor consumer placements and assist with identifying appropriate and least restrictive treatment options.Communicate findings, recommendations, and utilization concerns to appropriate stakeholders.Prepare utilization reports and provide data-driven recommendations to support regional behavioral health planning and resource management.Promote quality, cost-effective care while supporting timely access to appropriate services.Participate in regional initiatives and activities designed to improve behavioral health system coordination and outcomes.BENEFITSHealth, Vision, and Dental InsuranceVirginia Retirement SystemFlexible Spending Account (FSA)Life Insurance11 Paid Holidays The selected candidate must successfully pass a criminal history fingerprint background investigation, DMV record check, Child Registry search, drug screening test and employment reference checks.
Job Posted by ApplicantPro