... Manager oversees utilization management including, but not limited to: utilization review, case documentation, payer relationships, regulatory requirements, staff management and department ...
New
... Manager oversees utilization management including, but not limited to: utilization review, case documentation, payer relationships, regulatory requirements, staff management and department ...
New
Utilization Review Manager - SUD | Anabranch Recovery Center | Terre Haute, Indiana About the Job: The Utilization Management Manager is responsible for the overall management of the UM department by ...
Utilization Review Manager - SUD | Anabranch Recovery Center | Terre Haute, Indiana About the Job: The Utilization Management Manager is responsible for the overall management of the UM department by ...
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... UR contacts external case managers/managed care organizations for certification of insurance ...
New
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... UR contacts external case managers/managed care organizations for certification of insurance ...
New
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... UR contacts external case managers/managed care organizations for certification of insurance ...
New
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... UR contacts external case managers/managed care organizations for certification of insurance ...
New
UR contacts external case managers/managed care organizations for certification of insurance ... Previous utilization review experience in a psychiatric healthcare facility preferred. * License:
UR contacts external case managers/managed care organizations for certification of insurance ... Previous utilization review experience in a psychiatric healthcare facility preferred. * License:
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... UR contacts external case managers/managed care organizations for certification of insurance ...
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... UR contacts external case managers/managed care organizations for certification of insurance ...
UR contacts external case managers/managed care organizations for certification of insurance ... Previous utilization review experience in a psychiatric healthcare facility preferred. * License:
UR contacts external case managers/managed care organizations for certification of insurance ... Previous utilization review experience in a psychiatric healthcare facility preferred. * License:
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... UR contacts external case managers/managed care organizations for certification of insurance ...
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... UR contacts external case managers/managed care organizations for certification of insurance ...
Prior utilization review, case management, or payer review experience preferred * Strong knowledge of Medicare, Medicaid, and commercial insurance guidelines * Solid understanding of clinical care ...
Prior utilization review, case management, or payer review experience preferred * Strong knowledge of Medicare, Medicaid, and commercial insurance guidelines * Solid understanding of clinical care ...
Prior utilization review, case management, or payer review experience preferred * Strong knowledge of Medicare, Medicaid, and commercial insurance guidelines * Solid understanding of clinical care ...
Prior utilization review, case management, or payer review experience preferred * Strong knowledge of Medicare, Medicaid, and commercial insurance guidelines * Solid understanding of clinical care ...
Prior utilization review, case management, or payer review experience preferred * Strong knowledge of Medicare, Medicaid, and commercial insurance guidelines * Solid understanding of clinical care ...
Prior utilization review, case management, or payer review experience preferred * Strong knowledge of Medicare, Medicaid, and commercial insurance guidelines * Solid understanding of clinical care ...
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 ...
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 ...
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 ...
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 ...
UTILIZATION REVIEW RN
Seymour, IN · On-site
Bachelors Degree in Nursing with case management certification LICENSE/CERTIFICATION Licensed RN in ... DUTIES 1. Utilization Review and Medical Necessity 2. Concurrent Review and Length of Stay ...
UTILIZATION REVIEW RN
Seymour, IN · On-site
Bachelors Degree in Nursing with case management certification LICENSE/CERTIFICATION Licensed RN in ... DUTIES 1. Utilization Review and Medical Necessity 2. Concurrent Review and Length of Stay ...
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 ...
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 ...
Utilization Review RN
$30 - $34/hr
Strong computer skills, positive attitude, and ability to hit high production goals is what the manager is looking for here. Expected to review 20 cases a day with a 95% accuracy rate. Responsible ...
Utilization Review RN
$30 - $34/hr
Strong computer skills, positive attitude, and ability to hit high production goals is what the manager is looking for here. Expected to review 20 cases a day with a 95% accuracy rate. Responsible ...
May also manage appeals for services denied. * Conducts pre-certification, inpatient, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with ...
May also manage appeals for services denied. * Conducts pre-certification, inpatient, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with ...
... thorough review of the total resources available to patient pre and post-discharge from ... Functions as liaison with payer representatives to manage the rehabilitation process in keeping ...
Quick apply
... thorough review of the total resources available to patient pre and post-discharge from ... Functions as liaison with payer representatives to manage the rehabilitation process in keeping ...
... thorough review of the total resources available to patient pre and post-discharge from ... Functions as liaison with payer representatives to manage the rehabilitation process in keeping ...
... thorough review of the total resources available to patient pre and post-discharge from ... Functions as liaison with payer representatives to manage the rehabilitation process in keeping ...
Coordinates, performs, and monitors all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization ...
Coordinates, performs, and monitors all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization ...
Manager Optum Utilization Review information
What does a Manager of 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.
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.
How does a Manager in 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 is the difference between Manager Optum Utilization Review vs Utilization Review Nurse?
| Aspect | Manager Optum Utilization Review | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires a nursing license, certifications in case management or utilization review | Registered Nurse (RN) license, certifications in case management or utilization review |
| Work Environment | Supervises teams, manages review processes, collaborates with healthcare providers | Conducts patient reviews, assesses medical necessity, documents findings |
| Employer & Industry Usage | Common in health insurance companies, managed care organizations, healthcare providers | Primarily 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 Indiana? The most popular types of Optum Utilization Review jobs in Indiana are:
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What job categories do people searching Manager Optum Utilization Review jobs in Indiana look for? The top searched job categories for Manager Optum Utilization Review jobs in Indiana are:
What cities in Indiana are hiring for Manager Optum Utilization Review jobs? Cities in Indiana with the most Manager Optum Utilization Review job openings:
Universal Health Services rating
6.8
Based on 253 frontline employees who took The Breakroom Quiz
493rd of 887 rated healthcare providers
Job description
Responsibilities
The Utilization Management Manager oversees utilization management including, but not limited to: utilization review, case documentation, payer relationships, regulatory requirements, staff management and department administration. Supports the overall success of the hospital and promotes patient satisfaction, regulatory compliance and optimal reimbursement.
Qualifications
QUALIFICATIONS
Education :Must have Registered Nurse license or Master's Degree.
Experience: 5-7 yrs acute inpatient psychiatric setting as a treatment team member experience or 3-5 years of experience in utilization management for both mental health and substance abuse behavioral health disorders experience.
Work Location: In person
The Utilization Management Manager oversees utilization management including, but not limited to: utilization review, case documentation, payer relationships, regulatory requirements, staff management and department administration. Supports the overall success of the hospital and promotes patient satisfaction, regulatory compliance and optimal reimbursement.
Qualifications
QUALIFICATIONS
Education :Must have Registered Nurse license or Master's Degree.
Experience: 5-7 yrs acute inpatient psychiatric setting as a treatment team member experience or 3-5 years of experience in utilization management for both mental health and substance abuse behavioral health disorders experience.
Work Location: In person
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About Universal Health Services
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Universal Health Services (UHS) is a major player in the healthcare industry, based in King of Prussia, Pennsylvania, U.S. Founded in 1978, UHS offers hospital and healthcare services. Their diverse services range from acute care hospitals, behavioral health facilities and ambulatory centers nationwide. The company's mission of enhancing the health and well-being of their patients is reflected in their commitment to 'Helping Individuals Live Longer, Healthier and Happier Lives'. Universal Health Services' consistent growth and success in their industry have been recognized on numerous occasions, including being ranked amongst the Fortune 500 list of largest companies.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
King of Prussia, PA, US