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Manager Optum Utilization Review Jobs in Indiana

Beacon Health System

W/Alt UM Nurse (BHS)

Granger, IN · On-site

Critical utilization management functions during the admission phase include admission review for medical necessity and appropriate patient status using standardized inpatient utilization criteria.

Beacon Health System

W/Alt UM Nurse (BHS)

Granger, IN · On-site

Critical utilization management functions during the admission phase include admission review for medical necessity and appropriate patient status using standardized inpatient utilization criteria.

Beacon Health System

W/Alt UM Nurse (BHS)

Granger, IN · On-site

Critical utilization management functions during the admission phase include admission review for medical necessity and appropriate patient status using standardized inpatient utilization criteria.

TEEMA Group

RN Care Manager

Evansville, IN · On-site

$85K - $95K/yr

Perform utilization review (UR) and payer communication * Support hospital goals: reduce LOS ... Case Management * Discharge Planning * Utilization Review (UR/UM) * Home Health or Care ...

ScionHealth

ZZZCase Manager II PRN

Indianapolis, IN · On-site

... utilization review and management, and discharge planning. Essential Functions Care Coordination ... Coordinates clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians.

EDGEWATER HEALTH

NURSE MANAGER

Gary, IN

SUMMARY/OBJECTIVES The Nurse Manager provides clinical leadership, operational oversight, and ... Ensures standards for admission, utilization review, and concurrent review are followed. Staff ...

Edgewater Health

The Nurse Manager evaluates the health needs of clients, oversees medication management, develops ... Ensures standards for admission, utilization review, and concurrent review are followed. Staff ...

Edgewater Health

NURSE MANAGER

Gary, IN · On-site

$95 - $125/hr

The Nurse Manager evaluates the health needs of clients, oversees medication management, develops ... Ensures standards for admission, utilization review, and concurrent review are followed. Staff ...

UHS

UR Coordinator (PRN)

Kouts, IN · On-site

... managed care companies, insurance companies and other third party reviewers to establish the length of stay or number of certified days. • Coordinate with the insurance company doctor in appeals ...

Acadia Healthcare

Utilization Assistant

Fort Wayne, IN · On-site

... peer review. * Informs management about the status of current patients; documents utilization ... activities as instructed. Participates in performance improvement activities. OTHER FUNCTIONS:

New

Acadia Healthcare

Utilization Assistant

Fort Wayne, IN · On-site

... review. * Informs management about the status of current patients; documents utilization activities as instructed. Participates in performance improvement activities. OTHER FUNCTIONS: * Perform other ...

Deaconess

Clinical Denial Analyst (RN)

Evansville, IN · On-site

$28.71 - $40.19/hr

Minimum of two (2) years performing utilization review, charge audit, case management or similar functions in an acute care or specialty hospital Preferred Certification/License/Experience: * BSN

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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.

W/Alt UM Nurse (BHS)

Beacon Health System

Granger, IN • On-site

Full-time

Re-posted 10 days ago

Beacon Health System rating

6.7

Company rating: 6.7 out of 10

Based on 144 frontline employees who took The Breakroom Quiz

534th of 893 rated healthcare providers

Job description

Reports to the Manager, Utilization Management Department. Serves as a liaison between Memorial Hospital, physicians, third-party payers and auditors to ensure information needs are met. This position will be deployed from the Summit Center, working closely with nursing supervisors, physicians admitting patients through the Emergency Department, Direct Admissions and surgical patients. The pre-admission phase incorporates all of the activities that occur prior to patient arriving in the hospital bed. Responsibilities include: ED review for correct patient classification (inpatient vs outpatient with Observation services), Direct admit and transfer review for correct patient classification (inpatient vs outpatient with observation services), elective surgery review for Medicare inpatient only procedures. Critical utilization management functions during the admission phase include admission review for medical necessity and appropriate patient status using standardized inpatient utilization criteria. Case management activities in alignment with the revenue cycle include: Providing clinical review to payers for urgent/emergent admissions, admission InterQual/MCG review of all bedded patients, Medicare 2nd level physician review referral, collaborate with admitting team to establish appropriate status, confirm order and registration match.
MISSION, VALUES and SERVICE GOALS
  • MISSION: We deliver outstanding care, inspire health, and connect with heart.
  • VALUES: Trust. Respect. Integrity. Compassion.
  • SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Maintains systems for monitoring patient admissions and extended stays for appropriateness and medical necessity by:
  • Reviewing patient admission clinical information using clinical criteria and guidelines available to assist the physician in the determination of medical necessity and/or appropriate admission status (inpatient or outpatient).
  • Communicating, in a timely manner, with third-party payors to justify admission or continued stay.
  • Reviewing extended stays prior to expiration of initially-assigned length of stay.
  • Referring questionable medical necessity or extended stays to the Manager/Director, treating Physician (or Medical Director) as appropriate.
  • Interacting with other Hospital departments in matters related to review decisions and fiscal communications.
  • Facilitating discharge planning by working closely with Nurses and Clinical Social Workers and/or Therapists.
  • These functions apply to associates assigned to Epworth Center only:
  • Maintains system for monitoring and completing Medicare Certification/ Recertification for inpatient psychiatric services.
  • Submission of 1261A forms within 14 days of admission for each Medicaid Psychiatric admission.

Anticipates and reviews denials and facilitates the appeal process by:
  • Anticipating and reviewing denials by payors for lack of medical necessity, inadequate medical information or delay in discharge; also intervening by written appeal to avoid loss of revenue.
  • Arranging physician-to-physician clinical reviews with insurance company, Medical Director and Attending Physician.
  • Writing denial appeal letters on behalf of the patient and/or the Hospital, when appropriate, to avoid loss of revenue.
  • Coordinating with the Manager/Director (and other management as appropriate) to identify and correct weaknesses in the admission and patient care process that can mitigate future denials.
  • Issuing Notices of Non-coverage (insurance &/or Medicare) to patients as necessary.

Serves as a Memorial Hospital and Beacon Health System resource regarding reimbursement by:
  • Maintaining knowledge regarding current regulations (PRO, TJC, AHA, etc.) which impact utilization review activities.
  • Meeting with physicians, Hospital staff, review agencies, insurance companies and others (as relevant) in the assessment of utilization needs.
  • Educating patients and patients families regarding Medicare regulations and issues, and notices of non-coverage when appropriate.
  • Identifying risk issues concurrently with clinical reviews to provide the Hospital management with valid information on potentially compensable events; also communicating with the Manager/Director and the Director, Risk Management.

Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by:
  • Looking for opportunities to improve departmental operations, patient care delivery and utilization of acute healthcare resources; also striving for continuous quality improvement.
  • Staying current on trends related to medical necessity, DRG and Recovery Audit Contractor (RAC).
  • Completing other job-related assignments and special projects as directed.
ORGANIZATIONAL RESPONSIBILITIES
Associate complies with the following organizational requirements:
  • Attends and participates in department meetings and is accountable for all information shared.
  • Completes mandatory education, annual competencies and department specific education within established timeframes.
  • Completes annual employee health requirements within established timeframes.
  • Maintains license/certification, registration in good standing throughout fiscal year.
  • Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
  • Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
  • Adheres to regulatory agency requirements, survey process and compliance.
  • Complies with established organization and department policies.
  • Available to work overtime in addition to working additional or other shifts and schedules when required.

Commitment to Beacon's six-point Operating System, referred to as The Beacon Way:
  • Leverage innovation everywhere.
  • Cultivate human talent.
  • Embrace performance improvement.
  • Build greatness through accountability.
  • Use information to improve and advance.
  • Communicate clearly and continuously.

Education and Experience:
The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a Nursing program. A valid and current Registered Nurse license in the state of Indiana is required. Two years of clinical experience is required. Two years of progressively responsible experience in a utilization review environment is preferred.
Knowledge & Skills:
  • Requires fundamental knowledge of the revenue cycle process, which includes such things as patient access, utilization review, charge capture, HIM and patient accounting.
  • Requires the advanced analytical and critical thinking skills necessary to audit patient care data, associated patient care documentation and identify variances in standards of care.
  • Requires knowledge of rules and regulations pertaining to hospital reimbursement.
  • Requires familiarity with managed care principles and an understanding of post-acute continuum of care.
  • Requires the interpersonal skills necessary to maintain effective working relationships and interact effectively with staff, physicians, review agencies, insurance companies, patients and patients families.
  • Requires the effective communication skills (both verbal and written) necessary to prepare documentation, write appeal letters and to provide education to staff and physicians regarding the revenue cycle process.
  • Demonstrates the ability to be self-motivated, detail oriented and make independent decisions. Also demonstrates the ability to respond quickly and appropriately to customer requests.
  • Demonstrates a working knowledge of the Hospitals computer systems (e.g., Star McKesson, Cerner Power Chart) and proficiency in computer skills (i.e., word processing, spreadsheets, utilizing the internet, etc.).

Working Conditions:
  • Deployed through the Summit Center and will be working closely with physicians admitting patients through the ECC. Will be working closely with Summit Nursing Supervisors and admitting physicians for patient who are transfers from other facilities and direct admissions.
  • May have contact with patients and family members who may be under considerable stress.
  • May be exposed to bio-hazards.
  • Must commit to a weekend alternative schedule.

Physical Demands:
Requires the physical ability and stamina to perform the essential functions of the position. Will be moving between Summit, the ECC and the surgical areas multiple times through-out the shift (based upon volumes of admissions through these areas).

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