Concurrent Review Nurse
Troy, MI · On-site
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare ...
Concurrent Review Nurse
Troy, MI · On-site
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare ...
In this position you will be reviewing patient charts to determine if pre-elective surgical cases ... Previous utilization management or case management experience preferred. CERTIFICATIONS/LICENSURES ...
In this position you will be reviewing patient charts to determine if pre-elective surgical cases ... Previous utilization management or case management experience preferred. CERTIFICATIONS/LICENSURES ...
Access-Utilization Manager
Port Huron, MI · On-site
... and Utilization Review (UR) activities across the CMH and SUD provider networks, including case ... Management Program Plan Provide lead clinical support and participation on Region 10 committees ...
Access-Utilization Manager
Port Huron, MI · On-site
... and Utilization Review (UR) activities across the CMH and SUD provider networks, including case ... Management Program Plan Provide lead clinical support and participation on Region 10 committees ...
Care Review Clinician - UR RN
Troy, MI · On-site
Utilization Review background in either Managed Care of Provider environment (at least one year) RN License in Michigan Interqual experience (at least one year) Minimum 2-4 years of clinical practice.
Care Review Clinician - UR RN
Troy, MI · On-site
Utilization Review background in either Managed Care of Provider environment (at least one year) RN License in Michigan Interqual experience (at least one year) Minimum 2-4 years of clinical practice.
Utilization Management - Through retrospective review and use of both strong QI principles and strong data aggregation and analysis skills, the Utilization Management Coordinator will: * Perform ...
Utilization Management - Through retrospective review and use of both strong QI principles and strong data aggregation and analysis skills, the Utilization Management Coordinator will: * Perform ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental needs. * Plans, implements, and documents utilization management activities which ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental needs. * Plans, implements, and documents utilization management activities which ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental needs. * Plans, implements, and documents utilization management activities which ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental needs. * Plans, implements, and documents utilization management activities which ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental needs. * Plans, implements, and documents utilization management activities which ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and departmental needs. * Plans, implements, and documents utilization management activities which ...
Utilization Management - Through retrospective review and use of both strong QI principles and strong data aggregation and analysis skills, the Utilization Management Coordinator will: Perform ...
Utilization Management - Through retrospective review and use of both strong QI principles and strong data aggregation and analysis skills, the Utilization Management Coordinator will: Perform ...
Leads the Government Programs utilization management (UM) compliance functions, including the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC ...
Leads the Government Programs utilization management (UM) compliance functions, including the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC ...
Behavioral Health Utilization Management Specialist
Hastings, MI · On-site
$58K/yr
This role is responsible for reviewing behavioral health services to ensure medical necessity ... The ideal candidate brings strong clinical judgment, experience with managed care or utilization ...
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Behavioral Health Utilization Management Specialist
Hastings, MI · On-site
$58K/yr
This role is responsible for reviewing behavioral health services to ensure medical necessity ... The ideal candidate brings strong clinical judgment, experience with managed care or utilization ...
Leads the Government Programs utilization management (UM) compliance functions, including the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC ...
Leads the Government Programs utilization management (UM) compliance functions, including the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC ...
Leads the Government Programs utilization management (UM) compliance functions, including the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC ...
Leads the Government Programs utilization management (UM) compliance functions, including the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC ...
Leads the Government Programs utilization management (UM) compliance functions, including the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC ...
Leads the Government Programs utilization management (UM) compliance functions, including the National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC ...
This position manages the Utilization Review Staff and ensures compliance with regulatory requirements related to the appropriateness and medical necessity of care provided. The Manager provides ...
This position manages the Utilization Review Staff and ensures compliance with regulatory requirements related to the appropriateness and medical necessity of care provided. The Manager provides ...
Utilization Mgmt Spec
Southfield, MI · On-site
Provides clerical support for Utilization Management; sorting faxes and mail, obtaining authorization numbers, completing follow-up on outstanding cases, and delivery of letters associated with ...
Utilization Mgmt Spec
Southfield, MI · On-site
Provides clerical support for Utilization Management; sorting faxes and mail, obtaining authorization numbers, completing follow-up on outstanding cases, and delivery of letters associated with ...
Utilization Mgmt Spec
Southfield, MI · On-site
Provides clerical support for Utilization Management; sorting faxes and mail, obtaining authorization numbers, completing follow-up on outstanding cases, and delivery of letters associated with ...
Utilization Mgmt Spec
Southfield, MI · On-site
Provides clerical support for Utilization Management; sorting faxes and mail, obtaining authorization numbers, completing follow-up on outstanding cases, and delivery of letters associated with ...
Utilization Mgmt Spec
Southfield, MI · On-site
Provides clerical support for Utilization Management; sorting faxes and mail, obtaining authorization numbers, completing follow-up on outstanding cases, and delivery of letters associated with ...
Utilization Mgmt Spec
Southfield, MI · On-site
Provides clerical support for Utilization Management; sorting faxes and mail, obtaining authorization numbers, completing follow-up on outstanding cases, and delivery of letters associated with ...
Director of Utilization Management
Troy, MI · On-site +1
$160K - $160K/yr
Prepare and maintain Utilization Review Plan policies and procedures * Obtain or maintain ... Manage UM Department, clinical and non-clinical staff, to ensure timely review of prior ...
Director of Utilization Management
Troy, MI · On-site +1
$160K - $160K/yr
Prepare and maintain Utilization Review Plan policies and procedures * Obtain or maintain ... Manage UM Department, clinical and non-clinical staff, to ensure timely review of prior ...
Utilization Mgmt Spec
Climax, MI · On-site
Provides clerical support for Utilization Management; sorting faxes and mail, obtaining authorization numbers, completing follow-up on outstanding cases, and delivery of letters associated with ...
Utilization Mgmt Spec
Climax, MI · On-site
Provides clerical support for Utilization Management; sorting faxes and mail, obtaining authorization numbers, completing follow-up on outstanding cases, and delivery of letters associated with ...
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 Michigan?
The most popular types of Optum Utilization Review jobs in Michigan are:
What are popular job titles related to Manager Optum Utilization Review jobs in Michigan?
For Manager Optum Utilization Review jobs in Michigan, the most frequently searched job titles are:
- Medical Review Coordinator
- Weekend Physician Advisor Utilization Review
- Optum Clinical Claim Review Nurse
- Remote Telephonic Nurse
- No Experience Utilization Management Nurse
- Rn Legal Nurse Chart Review
- Remote Prior Authorization Nurse
- Remote Case Reviewer
- Registered Nurse Utilization Review
- Utilization Review Physician
What job categories do people searching Manager Optum Utilization Review jobs in Michigan look for?
The top searched job categories for Manager Optum Utilization Review jobs in Michigan are:
Job description
Company Description
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!
Job Description
Company Job Description/Day to Day Duties:
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines
Provider appeals and Utilization reviews and assist with Denial Letters
Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization Management team.
Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.
Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care.
Qualifications
Minimum Education/Qualifications/Licensures:
Utilization Review background in either Managed Care of Provider environment (at least one year)
Interqual experience
Other basic computer skills necessary: Microsoft Office, Data Entry, etc.
Minimum 2-4 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management.
Also has a background in patient, skilled nurses facilities, rehab, and home healthcare.
Additional Information
Are you an experienced Registered Nurse looking for a new opportunity with a prestigious healthcare company in Troy MI? Do you want the chance to advance your career by joining a rapidly growing company? If you answered "yes" to any of these questions - this is the position for you!
About Healthcare Support
Sourced by ZipRecruiter
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.
Industry
Recruiting and staffing services
Company size
201 - 500 Employees
Headquarters location
Maitland, FL, US
Year founded
2003