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Manager Optum Utilization Review Jobs in Tennessee

UHS

Full-time - UR Coordinator

Memphis, TN · On-site

Oversees utilization review activities with other departments to ensure reimbursement for services ... The UM Coordinator has a working knowledge of all levels of care offered and appropriately manages ...

UHS

Full-time - UR Coordinator

Memphis, TN

Oversees utilization review activities with other departments to ensure reimbursement for services ... The UM Coordinator has a working knowledge of all levels of care offered and appropriately manages ...

genex

Onsite Telephonic Case Manager (RN)

Memphis, TN · On-site

Responsible for the performance of Utilization Review services, including pre-admission ... Report to Branch Manager/Supervisor potential problems identified during reviews or data collection ...

Genex

Onsite Telephonic Case Manager (RN)

Memphis, TN · On-site

Provision of comprehensive Utilization Management, incorporating the strategies of cost containment ... Responsible for the performance of Utilization Review services, including pre-admission ...

UHS

UM Coordinator - Full-time days

Memphis, TN · On-site

Oversees utilization review activities with other departments to ensure reimbursement for services ... The UM Coordinator has a working knowledge of all levels of care offered and appropriately manages ...

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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 Tennessee?

The most popular types of Optum Utilization Review jobs in Tennessee are:

What are popular job titles related to Manager Optum Utilization Review jobs in Tennessee?

For Manager Optum Utilization Review jobs in Tennessee, the most frequently searched job titles are:

What job categories do people searching Manager Optum Utilization Review jobs in Tennessee look for?

The top searched job categories for Manager Optum Utilization Review jobs in Tennessee are:

What cities in Tennessee are hiring for Manager Optum Utilization Review jobs?

Cities in Tennessee with the most Manager Optum Utilization Review job openings:

Manager Optum Utilization Review jobs near you

Utilization Management Nurse RN

Signature HealthCARE, LLC

Antioch, TN • On-site

$75K - $82K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted yesterday

Signature Healthcare rating

5.3

Company rating: 5.3 out of 10

Based on 173 frontline employees who took The Breakroom Quiz

196th of 247 rated social care providers

Job description

Signature HealthCARE is a family-based healthcare company offering integrated services across multiple states. Our continuum of care includes skilled nursing, rehabilitation, assisted and memory care, and home-based services supported by innovative technologies like telehealth and Care.ai-enabled solutions.
We are committed to advancing person-directed care and quality outcomes. Many of our facilities continue to receive high performance ratings and accreditations. As an award-winning organization recognized over the years by national outlets such as U.S. News & World Report, we take pride in fostering compassionate care environments and being an employer of choice in the healthcare industry.
Overview
Collaboration with Managed Care Organizations (MCO) and care providers is vital to ensure care is being delivered in the right setting at the right time.
How you Will make a difference
  • Collaborate regularly and maintain open communication with leadership, patients, families, internal care givers, and external Utilization Management Nurses.
  • Coordinate internal and external health care team activities related to resident care, transitions and discharge planning with agencies, and other healthcare organizations.
  • Conduct initial baseline assessment of resident care needs and communicate that effectively to the Managed Care Organization (MCO) ensuring all aspects of care services are communicated accurately.
  • Verify all care needs and the authorization for services and outliers.
  • Communicate/collaborate with the Managed Care Organization (MCO) at required intervals as determined by the MCO
  • Negotiate appropriate levels based on services provided and contractual arrangements with the facility and the MCO.
  • Document all authorizations and continued stay activity in Case Management software to ensure appropriate reporting and billing
  • Prepare all Managed Care documentation to facility accurate billing.

What you Need to make a Difference
  • Registered Nurse (RN) in good standing with required current state license.
  • Associates degree required, but Bachelor's degree preferred.
  • Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or Interqual.
  • Minimum of three (3) years related case management experience.
  • Minimum of three (3) years of hospital, SNF or Acute Rehab clinical experience
  • Certified in Case Management through ACMA, CCMC or other credentialed agencies, preferred or willing to obtain after one year of employment.
  • Knowledge of Medicare payment methodology and the MDS RUG system. Previous experience with MDS and assessment preferred

Our exceptional Benefits Package and Signature Perks include the following and more!
  • Medical, Dental and Vision - Voluntary Life/Disability
  • Free Telemedicine with Medical Plan
  • 401(K) and Roth 401(K)
  • Tuition Forgiveness/Education Reimbursement
  • A variety of additional specialized Insurances
  • Pay Advance and Next Day Pay!
  • Paid Time Off (PTO)
  • Partner Perks and Discounts!
  • Reward & Recognition Program (HEART)
  • Vital Links

At Signature HealthCARE, our team members are permitted - no, encouraged - to employ their talents and abilities to solve problems.
Our culture is built on three distinct pillars: Learning, Spirituality and Intra-preneurship.
Each pillar has its own staff and initiatives, ensuring that our unique culture permeates the entire organization.
Come see what the revolution is all about!
Signature HealthCARE is an Equal Opportunity-Affirmative Action Employer - Minority / Female / Disability / Veteran and other protected categories
Salary Range
USD $75,000.00 - USD $82,000.00 /Yr.
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