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 ...
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 ...
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 ...
... 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 ...
... 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 ...
The Director of Utilization Management is responsible for the overall management of the UM department by leading and facilitating review of assigned admissions, continued stays, utilization practices ...
The Director of Utilization Management is responsible for the overall management of the UM department by leading and facilitating review of assigned admissions, continued stays, utilization practices ...
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 ...
... 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 ...
... 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 ...
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 ...
... managed care concepts. Must have good verbal and written communication skills. Must have excellent people skills and the ability to solve problems efficiently and effectively. Must have good ...
... managed care concepts. Must have good verbal and written communication skills. Must have excellent people skills and the ability to solve problems efficiently and effectively. Must have good ...
Utilization Review Analyst
Fort Wayne, IN · On-site
$13.05 - $19.57/hr
Other Qualifications Demonstrates understanding of managed care concepts. Must have good verbal and written communication skills. Must have excellent people skills and the ability to solve problems ...
Utilization Review Analyst
Fort Wayne, IN · On-site
$13.05 - $19.57/hr
Other Qualifications Demonstrates understanding of managed care concepts. Must have good verbal and written communication skills. Must have excellent people skills and the ability to solve problems ...
Utilization Review Analyst
Fort Wayne, IN · On-site
... managed care concepts. Must have good verbal and written communication skills. Must have excellent people skills and the ability to solve problems efficiently and effectively. Must have good ...
Utilization Review Analyst
Fort Wayne, IN · On-site
... managed care concepts. Must have good verbal and written communication skills. Must have excellent people skills and the ability to solve problems efficiently and effectively. Must have good ...
Utilization Review Analyst
Fort Wayne, IN · On-site
... managed care concepts. Must have good verbal and written communication skills. Must have excellent people skills and the ability to solve problems efficiently and effectively. Must have good ...
Utilization Review Analyst
Fort Wayne, IN · On-site
... managed care concepts. Must have good verbal and written communication skills. Must have excellent people skills and the ability to solve problems efficiently and effectively. Must have good ...
Utilization Review Analyst
Fort Wayne, IN · On-site
$13.05 - $19.57/hr
Other Qualifications Demonstrates understanding of managed care concepts. Must have good verbal and written communication skills. Must have excellent people skills and the ability to solve problems ...
Utilization Review Analyst
Fort Wayne, IN · On-site
$13.05 - $19.57/hr
Other Qualifications Demonstrates understanding of managed care concepts. Must have good verbal and written communication skills. Must have excellent people skills and the ability to solve problems ...
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:
What are popular job titles related to Manager Optum Utilization Review jobs in Indiana? For Manager Optum Utilization Review jobs in Indiana, the most frequently searched job titles are:
- Cvs Health Utilization Management
- Remote Utilization Management Pharmacist
- Telephonic Nurse Case Manager
- Utilization Management Coordinator
- Registered Nurse Utilization Review
- Commission Cvs Health Utilization Management
- Temporary Admission Discharge Nurse
- Remote Cvs Utilization Management Nurse
- Utilization Review Specialist
- Utilization Management
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:
Other
Medical, Dental, Vision, Retirement, PTO
Re-posted 10 days ago
Job description
About UsHealing Body and Mind.
NeuroPsychiatric Hospitals is a national leader in behavioral healthcare, specializing in patients with acute psychiatric and complex medical needs. Our hospitals use an interdisciplinary, multi-specialty approach that delivers high-quality, patient-centered care when it's needed most.
With locations in Indiana, Michigan, Texas, and Arizona, we're expanding access to our unique model of care across the United States. Join us and be part of a team dedicated to making a lasting difference in the lives of patients and families every day
OverviewNeuroPsychiatric Hospital of Indianapolis is looking for a Utilization Review Coordinator to coordinate patients' services across the continuum of care by promoting effective utilization, monitoring health resources and elaborating with multidisciplinary teams.
Benefits of joining NPH
- Competitive pay rates
- Medical, Dental, and Vision Insurance
- NPH 401(k) plan with up to 4% Company match
- Employee Assistance Program (EAP) Programs
- Generous PTO and Time Off Policy
- Special tuition offers through Capella University
- Work/life balance with great professional growth opportunities
- Employee Discounts through LifeMart
- Filing documents as needed.
- Initial Precertification with payors.
- Concurrent Clinical review with payors.
- Document in the electronic system daily in real time.
- Admission audit.
- Ensures that CON's/RON's and CMS certifications are completed by provider.
- Consistently demonstrates professionalism with all internal and external customers as evidenced by positive customer and peer Communicates effectively with all staff and patients as evidenced by the establishment and maintenance of productive working relationships.
- Maintains knowledge of current trends and developments in the field by reading appropriate books; journals and other literature and attending related seminars or conferences.
- Maintains a professional approach with Assures protection and privacy of health information as attained through written, electronic or oral disclosures.
- Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
- Seeks guidance and remains knowledgeable of, and complies with, all applicable federal and state laws, as well as hospital polices that apply.
- Complies with hospital expectations regarding ethical behavior and standards of conduct.
- Complies with federal and hospital requirements in the areas of protected health information and patient information.
- Reconsiderations, assists with appeals as needed, arrange peer to peer level reviews, and report the outcomes to the VP of Care Management and Team.
- Provides education to nursing staff. ;eadership team, and providers regarding documentation.
- Actively works with the business office regarding resolution of appeals/denials and retrospective reviews.
Education: Bachelor's in Behavioral Health, Social Work, Counseling, Nursing or Psychology required. Master's degree preferred.
Experience: 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 setting required.
Licensure: Certified Case Manager (CCM) or Accredited Case Manager (ACM) preferred. Basic Life Support (BLS) and Handle with Care (HWC) obtained during orientation, if applicable.
Skills: Must have strong knowledge of medications and demonstrate exceptional time management, data entry, and communication skills. Must be detail oriented.#INDEEDLOW
Employment Type: OTHER