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Manager Optum Utilization Review Jobs in Indiana

Major Hospital

UR Specialist-Non Exempt

Shelbyville, IN · On-site

Sound knowledge of applicable laws, regulations, and accreditation standards related to utilization review. Demonstrated ability to work independently and manage multiple priorities in a fast-paced ...

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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 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:

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:

Manager Optum Utilization Review jobs near you
Infographic showing various Manager Optum Utilization Review job openings in Indiana as of August 2026, with employment types broken down into 2% As Needed, 87% Full Time, 7% Part Time, 2% Temporary, and 2% Contract. Highlights an 86% In-person, 2% Hybrid, and 12% Remote job distribution.

Utilization Reviewer (UR) - Fulltime

Rehabilitation Hospital of Indiana

Indianapolis, IN • On-site

Full-time

Retirement

Posted 18 days ago

Job description

The Rehabilitation Hospital of Indiana (RHI) is nationally ranked among the Best Hospitals for Rehabilitation by U.S. News and World Report for 2025-2026 and the Best Rehabilitation Hospital in Indiana for the third year in a row. RHI provides high quality, evidence-based rehabilitation services to those facing life-changing injuries or illness.  RHI is the only Traumatic Brain Injury (TBI) Model System in the state of Indiana and one of only 16 in the U.S We offer a competitive compensation and benefits package, along with a 401k match and tuition reimbursement program.Summary:The Utilization Reviewer contributes to assessment and planning by performing a thorough review of the total resources available to patient pre and post-discharge from rehabilitation care. The Utilization Reviewer collaborates with the payer and rehabilitation team to ensure a successful transition to the discharge setting and or goal achievement, and durability of outcome.Essential FunctionsAssesses all of patient's payer sources for rehabilitation course, determines resources available for patient, and ensures maximal use of available health coverage resources for each patient.Completes pre-certification and prior authorization timely for admission and or services. Documents all insurance information appropriately on forms and in computer system as applicable. Functions as liaison with payer representatives to manage the rehabilitation process in keeping with the patient's financial resources, including verification of benefits for this and future settings.Completes retro authorizations as applicable and ensures follow through relative to authorizations for all services through the complete revenue cycle.Other duties as assigned.Education and ExperienceGreater than two (2) years of UR experience with a strong clinical background and competence with a rehabilitation populationBachelor's degree in related field with 3-5 years' experienceLPN or RN experience preferredHoursMonday - Friday (8:30am-5:00pm)This position is on-site at RHI The Rehabilitation Hospital of Indiana is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, sexual orientation, or any other characteristic protected by law.