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Manager Optum Utilization Review Jobs in Nevada (NOW HIRING)

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in ... Collaborate with physicians, case management, and care teams * Support discharge planning and care ...

Global Force

Utilization Review Nurse

Las Vegas, NV · On-site

Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance ... Minimum three (3) years of Utilization Management experience. * Minimum of three (3) year ...

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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.

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.

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 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 Nevada? The most popular types of Optum Utilization Review jobs in Nevada are:
What are popular job titles related to Manager Optum Utilization Review jobs in Nevada? For Manager Optum Utilization Review jobs in Nevada, the most frequently searched job titles are:
What job categories do people searching Manager Optum Utilization Review jobs in Nevada look for? The top searched job categories for Manager Optum Utilization Review jobs in Nevada are:
What cities in Nevada are hiring for Manager Optum Utilization Review jobs? Cities in Nevada 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 Nevada as of August 2026, with employment types broken down into 91% Full Time, 5% Part Time, 2% Temporary, and 2% Contract. Highlights an 86% In-person, 3% Hybrid, and 11% Remote job distribution.

Utilization Review Nurse

Fusion HCR

Las Vegas, NV • On-site

Other

Re-posted yesterday

Job description

Fusion HCR is hiring!Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care.
Overview
Seeking an experienced Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate level of care, and compliance with payer guidelines. This role works closely with clinical teams to ensure efficient resource utilization and quality patient outcomes.
Responsibilities
  • Review admissions using InterQual and/or Milliman criteria
  • Evaluate medical necessity, level of care, and documentation accuracy
  • Ensure compliance with Medicare, Medicaid, and regulatory guidelines
  • Collaborate with physicians, case management, and care teams
  • Support discharge planning and care coordination
  • Document findings and communicate recommendations

Requirements
  • Active RN license (Nevada)
  • 5+ years acute care nursing experience
  • 3+ years Utilization Review experience
  • 3+ years discharge planning experience (acute care)
  • Experience with InterQual (must be able to pass exam)
  • Experience with Milliman guidelines

Preferred
  • Background in Case Management or CDI
  • Strong knowledge of Joint Commission and CMS guidelines

Why Apply
  • Competitive pay
  • Stable, high-demand role
  • Collaborative healthcare environment

Apply Now
If you have strong Utilization Review, InterQual, and acute care experience, we want to hear from you!

Apply