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Manager Optum Utilization Review Jobs in Michigan

Integra Partners

Utilization Management Coordinator

Troy, MI · On-site +1

$19/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... to processing Utilization Management prior authorization sand appeals. JOB RESPONSIBILITIES ... Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS codes * Verify ...

UHS

UR COORDINATOR

Augusta, MI · On-site

  • Medical

Minimum of 1 years of experience in utilization review/case management preferred. * Minimum of 1 year facility based psychiatric/substance abuse experience preferred. EEO Statement All UHS ...

UHS

UR COORDINATOR

Augusta, MI · On-site

  • Medical

Minimum of 1 years of experience in utilization review/case management preferred. * Minimum of 1 year facility based psychiatric/substance abuse experience preferred. EEO Statement All UHS ...

UHS

UR COORDINATOR

Augusta, MI · On-site

  • Medical

Minimum of 1 years of experience in utilization review/case management preferred. * Minimum of 1 year facility based psychiatric/substance abuse experience preferred. EEO Statement All UHS ...

Healthcare Support Staffing

Care Review Clinician

Troy, MI · On-site

$33 - $37/hr

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...

G-TECH Services

RN-Clinical Review Analyst

Detroit, MI · On-site

$33 - $34/hr

  • Medical

  • Dental

  • Vision

  • Life

  • PTO

Prefer utilization management experience Additional Qualifications: * Two (2) to three (3) years of ... review, etc. * Demonstrated clinical knowledge and experience relative to patient care and health ...

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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 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:

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:

Manager Optum Utilization Review jobs near you

Utilization Management Coordinator

Integra Partners

Troy, MI • On-site, Remote

$19/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 7 days ago

Job description

The UM Coordinator assists and supports the clinical team (UM Nurses/Medical Director) with administrative and non-clinical tasks related to processing Utilization Management prior authorization sand appeals.
JOB RESPONSIBILITIES
  • Monitor incoming faxes
  • Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS codes
  • Verify eligibility and claim history in proprietary claims platform
  • Verify all necessary documentation has been submitted with authorization requests
  • Contact requesting providers to obtain medical records or other necessary documentation related to specific UM request
  • Generate correspondence and assist with faxing/mailing member and provider notifications
  • Complete verbal notifications
  • Document as required in authorization platform
  • Initiate appeal cases and forward to UM Nurses for completion
  • Meet internal and regulator deadlines for UM cases
  • Complete tasks assigned by UM Nurses and document as required
  • Complete inquiries received from call center and other internal & external sources
  • Other duties as assigned by UM Director
  • Strong organizational skills, ability to adapt quickly to change and desire to work in a fast-paced environment
  • Team oriented and self-motivated with a positive attitude

Pay: $19.00/hour
What will you learn in the first 6 months?
  • Verbal notifications
  • How to work in authorization systems Essette and Salesforce
  • Incoming/outgoing faxing process
  • Understanding the expectations and functions of the UM team
  • Time Management

What will you achieve in the first 12 months?
  • Expand knowledge of ICD-10 and HCPC codes
  • Maintaining expected timelines

EXPERIENCE:
  • 1 year as a UM Coordinator in a managed care payer environment preferred
  • Knowledge of ICD-10, HCPCS codes and medical terminology required
  • Ability to prioritize multiple tasks using time management and organizational skills
  • Strong computer skills with proficiency in Word, Outlook and other software applications
  • Ability to collect data, establish facts and draw valid conclusions
  • Effective written and oral communication skills
  • Experience with DMEPOS desired
  • Medicare/Medicaid experience a plus

Benefits Offered
  • Competitive compensation and annual bonus program
  • 401(k) retirement program with company match
  • Company-paid life insurance
  • Company-paid short term disability coverage (location restrictions may apply)
  • Medical, Vision, and Dental benefits
  • Paid Time Off (PTO)
  • Paid Parental Leave
  • Sick Time
  • Paid company holidays and floating holidays
  • Quarterly company-sponsored events
  • Health and wellness programs
  • Career development opportunities

Remote Opportunities
We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, Nevada, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington.
Our Story
Founded in 2005, Integra Partners is a leading national durable medical equipment, prosthetic, and orthotic supplies (DMEPOS) network administrator. Our mission is to improve the quality of life for the communities we serve by reimagining access to in-home healthcare. We connect Payers, Providers, and Members through innovative technology and streamlined workflows affording Members access to top local Providers and culturally competent care. By focusing on transparency, accountability, and adaptability, we help deliver better health outcomes and more efficient management of complex healthcare benefits.
With a location in Michigan plus a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We're looking for energetic, talented, and dedicated individuals to join our team. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in healthcare. We look forward to learning more about you.
Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don't hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.

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