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Manager Optum Utilization Review Jobs in Georgia

UHS

Utilization Review Nurse (RN)

Augusta, GA · On-site

Under the direction of the Director of Utilization Management. Website: Job Duties/ Responsibilities: * Review clinical content of medical records * Participate in treatment team meetings

UHS

Utilization Review Nurse (RN)

Augusta, GA · On-site

Utilization Review Nurse, RN Under the direction of the Director of Utilization Management. Website: Job Duties/ Responsibilities: * Review clinical content of medical records * Participate in ...

UHS

Utilization Review Nurse (RN)

Augusta, GA · On-site

Under the direction of the Director of Utilization Management. Website: Job Duties/ Responsibilities: * Review clinical content of medical records * Participate in treatment team meetings

UHS

Utilization Review Nurse (RN)

Augusta, GA

Utilization Review Nurse, RN Under the direction of the Director of Utilization Management. Website: Job Duties/ Responsibilities: * Review clinical content of medical records * Participate in ...

UHS

Utilization Review Nurse (RN)

Augusta, GA · On-site

Utilization Review Nurse, RN Under the direction of the Director of Utilization Management. Website: Job Duties/ Responsibilities: * Review clinical content of medical records * Participate in ...

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Manager Optum Utilization Review information

What does a manager Optum Utilization Review do?

A Manager of Optum Utilization Review oversees a team responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They ensure that all reviews comply with regulatory standards, company policies, and clinical guidelines. Managers also collaborate with healthcare providers, monitor team performance, and help implement process improvements to optimize patient outcomes and resource use. Their role is vital in balancing quality patient care with cost-effective service delivery.

How does a manager Optum Utilization Review typically collaborate with clinical and non-clinical teams to ensure effective case management?

As a Manager in Optum Utilization Review, you will regularly coordinate with clinical teams such as nurses, physicians, and case managers to review patient cases for medical necessity and compliance with policies. You’ll also work closely with non-clinical staff, including data analysts and administrative professionals, to streamline workflows and support accurate documentation. Effective collaboration ensures timely decision-making, helps resolve escalated cases, and supports continuous quality improvement initiatives. This role often requires strong communication and leadership skills to align multidisciplinary teams and achieve organizational goals.

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

To thrive as a Manager, Optum Utilization Review, you need a background in healthcare management, clinical expertise (often as an RN or related field), and experience with utilization management processes. Familiarity with utilization review software, electronic health records (EHRs), and relevant certifications such as CCM (Certified Case Manager) or URAC accreditation is typically required. Strong leadership, analytical thinking, and effective communication skills help you guide teams and collaborate with providers and payers. These competencies are crucial for ensuring compliance, optimizing patient care, and achieving organizational goals in a complex healthcare environment.

What is the difference between Manager Optum Utilization Review vs Utilization Review Nurse?

AspectManager Optum Utilization ReviewUtilization Review Nurse
CredentialsTypically requires a nursing license, certifications in case management or utilization reviewRegistered Nurse (RN) license, certifications in case management or utilization review
Work EnvironmentSupervises teams, manages review processes, collaborates with healthcare providersConducts patient reviews, assesses medical necessity, documents findings
Employer & Industry UsageCommon in health insurance companies, managed care organizations, healthcare providersPrimarily in hospitals, insurance companies, healthcare organizations

The main difference is that the Manager Optum Utilization Review oversees the review process and team management, while the Utilization Review Nurse focuses on conducting individual patient assessments and reviews. Both roles require nursing credentials and knowledge of healthcare policies, but the manager has additional responsibilities in leadership and process oversight.

What are the most commonly searched types of Optum Utilization Review jobs in Georgia?

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

What are popular job titles related to Manager Optum Utilization Review jobs in Georgia?

For Manager Optum Utilization Review jobs in Georgia, the most frequently searched job titles are:

What job categories do people searching Manager Optum Utilization Review jobs in Georgia look for?

The top searched job categories for Manager Optum Utilization Review jobs in Georgia are:

What cities in Georgia are hiring for Manager Optum Utilization Review jobs?

Cities in Georgia with the most Manager Optum Utilization Review job openings:

Manager Optum Utilization Review jobs near you
Infographic showing various Manager Optum Utilization Review job openings in Georgia as of June 2026, with employment types broken down into 1% As Needed, 85% Full Time, 13% Part Time, and 1% Temporary. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Manager Acute Care-Utilization Review

Southeast Georgia Health System

Brunswick, GA • On-site

Full-time

Posted 8 days ago

Southeast Georgia Health System rating

6.0

Company rating: 6.0 out of 10

Based on 27 frontline employees who took The Breakroom Quiz

Job description

Responsible for the planning, organization, and daily operations of the Utilization Review (UR) program to ensure accurate patient status determination, regulatory compliance, and optimal reimbursement. Provides direct supervision and leadership for the Utilization Review team while collaborating closely with physicians, Patient Status Officers (PSOs), Case Management, Coding, Clinical Documentation Integrity (CDI), and Revenue Cycle teams to ensure patients are assigned the appropriate level of care prior to discharge.
Directs concurrent medical necessity reviews using nationally recognized evidence-based criteria, including InterQual®, MCG®, and applicable commercial payer medical necessity guidelines, to support appropriate inpatient, observation, and outpatient status assignment. Monitors payer-specific authorization requirements and collaborates with commercial and governmental payers to proactively resolve patient status issues, minimize denials, and improve reimbursement outcomes.
Oversees secondary utilization reviews, payer escalations, peer-to-peer review coordination, medical necessity reconsiderations, and concurrent status appeals. Performs complex medical record reviews and provides clinical recommendations to support appropriate status determinations based on documented clinical evidence.
Maintains and updates the CMS-required Utilization Review Plan and ensures compliance with all applicable CMS Conditions of Participation, commercial payer requirements, and federal and state regulatory standards. Develops departmental policies, auditing processes, performance metrics, and staff education to promote regulatory compliance and continuous quality improvement.
Analyzes utilization trends, payer denials, avoidable observation conversions, and length-of-stay opportunities to improve operational performance and reduce post-discharge status denials. Partners with Patient Care Services, Transfer Center, Physician Leaders, Revenue Integrity Patient Financial Services, and Managed Care to support middle revenue cycle initiatives that improve revenue capture, reduce reimbursement risk, and enhance payer relationships.
Develops departmental goals, staffing plans, productivity standards, and annual operating budgets while monitoring financial performance and departmental outcomes. Promotes a collaborative, data-driven environment focused on regulatory compliance, patient status accuracy, operational efficiency, and physician and payer engagement.
Service Excellence: All team members of Southeast Georgia Health System will promote service excellence by developing and maintaining positive relationships with customers, other team members, and the medical staff and will ensure the highest quality of care by performing their responsibilities according to the highest professional standards.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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