... 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 ...
UTILIZATION REVIEW RN
Seymour, IN · On-site
Bachelors Degree in Nursing with case management certification LICENSE/CERTIFICATION Licensed RN in ... Utilization Review and Medical Necessity * Concurrent Review and Length of Stay Management
UTILIZATION REVIEW RN
Seymour, IN · On-site
Bachelors Degree in Nursing with case management certification LICENSE/CERTIFICATION Licensed RN in ... Utilization Review and Medical Necessity * Concurrent Review and Length of Stay Management
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 ...
Utilization Review Nurse RN Date: Sep 8, 2026 Location: Indianapolis, IN, US, 46202 Organization ... Responsible for managing each patient's plan of care, monitoring for appropriate resource ...
Utilization Review Nurse RN Date: Sep 8, 2026 Location: Indianapolis, IN, US, 46202 Organization ... Responsible for managing each patient's plan of care, monitoring for appropriate resource ...
Responsible for managing each patient's plan of care, monitoring for appropriate resource ... and perform Utilization Review using the Eskenazi Health approved clinical decision support ...
Responsible for managing each patient's plan of care, monitoring for appropriate resource ... and perform Utilization Review using the Eskenazi Health approved clinical decision support ...
Responsible for managing each patient's plan of care, monitoring for appropriate resource ... and perform Utilization Review using the Eskenazi Health approved clinical decision support ...
Responsible for managing each patient's plan of care, monitoring for appropriate resource ... and perform Utilization Review using the Eskenazi Health approved clinical decision support ...
Responsible for managing each patient's plan of care, monitoring for appropriate resource ... and perform Utilization Review using the Eskenazi Health approved clinical decision support ...
Responsible for managing each patient's plan of care, monitoring for appropriate resource ... and perform Utilization Review using the Eskenazi Health approved clinical decision support ...
Prior experience in utilization review, case management, discharge planning, prospective payment systems (DRGs), or the CMS Medicare Swing Bed Program. Mental/Physical Effort: Work 90% of the time in ...
Prior experience in utilization review, case management, discharge planning, prospective payment systems (DRGs), or the CMS Medicare Swing Bed Program. Mental/Physical Effort: Work 90% of the time in ...
Prior experience in utilization review, case management, discharge planning, prospective payment systems (DRGs), or the CMS Medicare Swing Bed Program. Mental/Physical Effort: Work 90% of the time in ...
Prior experience in utilization review, case management, discharge planning, prospective payment systems (DRGs), or the CMS Medicare Swing Bed Program. Mental/Physical Effort: Work 90% of the time in ...
Utilization Review RN
Indianapolis, IN · On-site
$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
Indianapolis, IN · On-site
$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
Indianapolis, IN · On-site
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 ...
Utilization Review RN
Indianapolis, IN · On-site
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 ...
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 ...
Overview NeuroPsychiatric Hospitals of Indianapolis is looking for a Utilization Review Coordinator ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
Overview NeuroPsychiatric Hospitals of Indianapolis is looking for a Utilization Review Coordinator ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
Overview NeuroPsychiatric Hospitals of Indianapolis is looking for a Utilization Review Coordinator ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
Overview NeuroPsychiatric Hospitals of Indianapolis is looking for a Utilization Review Coordinator ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
... 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 ...
NeuroPsychiatric Hospitals of Indianapolis is looking for a Utilization Review Coordinator to ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
NeuroPsychiatric Hospitals of Indianapolis is looking for a Utilization Review Coordinator to ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
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?
| 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:
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:
- Full Time Navihealth Utilization Review
- Utilization Review Coordinator
- Seasonal Remote Utilization Review
- Maternity Case Manager
- Remote Aetna Utilization Review
- Remote Lpn Utilization Review
- Remote Dental Utilization Management
- Remote Physical Therapy Utilization Review
- Work From Home Dental Utilization Review
- Remote Dental Utilization Review
What cities in Indiana are hiring for Manager Optum Utilization Review jobs?
Cities in Indiana with the most Manager Optum Utilization Review job openings:
Utilization Review Specialist
Lafayette, IN • On-site
Lifepoint Health
• Health Care and Social Assistance • 10K+ employees10,000+ employees
Full-time
Medical, Dental, Vision, Retirement, PTO
Re-posted 12 days ago
LifePoint Health rating
5.9
Based on 273 frontline employees who took The Breakroom Quiz
Job description
Your experience matters
At Sycamore Springs, we are committed to empowering and supporting a diverse and determined workforce who can drive quality, scalability, and significant impact across our hospitals and communities. In your role, you'll support those that are in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve.
What we offer
Fundamental to providing great care is supporting and rewarding our team. In addition to your base compensation, this position also offers:
- Health (Medical, Dental, Vision) and 401K Benefits for full-time employees
- Competitive Paid Time Off
- Employee Assistance Program - mental, physical, and financial wellness assistance
- Tuition Reimbursement/Assistance for qualified applicants
- And much more...
About Us
People are our passion and purpose. Sycamore Springs is a 48 bed hospital located in Layfette, IN and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier® with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestone-your experience matters
How you'll contribute
Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays. UR analyzes patient records to determine legitimacy of admission, treatment, and length of stay and interfaces with managed care organizations, external reviewers and other payers. UR advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric or emotional disorders to managed care providers for necessary treatment. UR contacts external case managers/managed care organizations for certification of insurance benefits throughout the patient's stay and assists the treatment team in understanding the insurance company's requirements for continued stay and discharge planning. This is a fully onsite position 5 days a week.
Essential Functions:
- Displays knowledge of clinical criteria, managed care requirements for inpatient and outpatient authorization and advocates on behalf of the patient to secure coverage for needed services
- Completes pre and re-certifications for inpatient and outpatient services. Reports appropriate denial, and authorization information to designated resource.
- Actively communicates with interdisciplinary team to acquire pertinent information and give updates on authorizations.
- Participate in treatment teams to ensure staff have knowledge of coverage and to collect information for communication with agencies.
- Works with DON to ensure documentation requirements are met.
- Ensure appeals are completed thoroughly and on a timely basis.
- Interface with managed care organizations, external reviews, and other payers.
- Communicate with physicians to schedule peer to peer reviews.
- Accurately report denials.
Qualifications and requirements
Bachelor's Degree
Previous utilization review experience in a psychiatric healthcare facility preferred.
EEOC Statement:
Sycamore Springs is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status or any other basis protected by applicable federal, state or local law.
About Us
Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.
About the Team
We employ and provide care to people from all walks of life. We are committed to promoting healing, providing hope, preserving dignity and producing value with an inclusive workforce in which diversity is leveraged, respected, and reflective of the patients, family members, customers and team members we serve.
What LifePoint Health employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About LifePoint Health
Sourced by ZipRecruiter
Lifepoint Health serves patients, clinicians, communities and partners across the healthcare continuum. Our diversified healthcare delivery network extends from coast to coast, consisting of community hospitals, rehabilitation and behavioral health hospitals, and additional sites of care.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Brentwood, TN, US
Year founded
1999