Utilization Review Assistant
Odessa, TX · On-site
Experience with the collection and management of data preferred. Familiar with medical terminology, utilization review, and/or medical insurance preferred. Ability to communicate effectively and ...
Utilization Review Assistant
Odessa, TX · On-site
Experience with the collection and management of data preferred. Familiar with medical terminology, utilization review, and/or medical insurance preferred. Ability to communicate effectively and ...
Experience with the collection and management of data preferred. Familiar with medical terminology, utilization review, and/or medical insurance preferred. Ability to communicate effectively and ...
Experience with the collection and management of data preferred. Familiar with medical terminology, utilization review, and/or medical insurance preferred. Ability to communicate effectively and ...
Utilization Review Assistant
Odessa, TX · On-site
Experience with the collection and management of data preferred. Familiar with medical terminology, utilization review, and/or medical insurance preferred. Ability to communicate effectively and ...
Utilization Review Assistant
Odessa, TX · On-site
Experience with the collection and management of data preferred. Familiar with medical terminology, utilization review, and/or medical insurance preferred. Ability to communicate effectively and ...
Experience with utilization management in behavioral and/or medical healthcare. Experience driving quality and timely discharge planning from residential facilities as deemed appropriate in review of ...
Experience with utilization management in behavioral and/or medical healthcare. Experience driving quality and timely discharge planning from residential facilities as deemed appropriate in review of ...
Experience with utilization management in behavioral and/or medical healthcare. Experience driving quality and timely discharge planning from residential facilities as deemed appropriate in review of ...
Experience with utilization management in behavioral and/or medical healthcare. Experience driving quality and timely discharge planning from residential facilities as deemed appropriate in review of ...
Experience with utilization management in behavioral and/or medical healthcare. Experience driving quality and timely discharge planning from residential facilities as deemed appropriate in review of ...
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Experience with utilization management in behavioral and/or medical healthcare. Experience driving quality and timely discharge planning from residential facilities as deemed appropriate in review of ...
Utilization Review Nurse
Dallas, TX · Remote
$35 - $45.94/hr
We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...
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Utilization Review Nurse
Dallas, TX · Remote
$35 - $45.94/hr
We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...
Utilization Review Nurse
Big Spring, TX · On-site
Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...
Utilization Review Nurse
Big Spring, TX · On-site
Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...
Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...
Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...
Hours: 8:30-5:30, Monday - Friday At Houston Methodist, the Utilization Review Nurse (URN) position ... This position collaborates with case management in the development and implementation of the plan ...
Hours: 8:30-5:30, Monday - Friday At Houston Methodist, the Utilization Review Nurse (URN) position ... This position collaborates with case management in the development and implementation of the plan ...
Utilization Review Nurse
Plano, TX · Remote
This position is responsible for performing initial, concurrent review activities; discharge care ... Provides information regarding utilization management requirements and operational procedures to ...
Utilization Review Nurse
Plano, TX · Remote
This position is responsible for performing initial, concurrent review activities; discharge care ... Provides information regarding utilization management requirements and operational procedures to ...
Utilization Management & Medical Necessity * Conduct admission, continued-stay, and discharge reviews for all patients based on: * InterQual ® , MCG, or payer-specific medical necessity criteria.
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Utilization Management & Medical Necessity * Conduct admission, continued-stay, and discharge reviews for all patients based on: * InterQual ® , MCG, or payer-specific medical necessity criteria.
Utilization Management & Medical Necessity * Conduct admission, continued-stay, and discharge reviews for all patients based on: * InterQual ® , MCG, or payer-specific medical necessity criteria.
Utilization Management & Medical Necessity * Conduct admission, continued-stay, and discharge reviews for all patients based on: * InterQual ® , MCG, or payer-specific medical necessity criteria.
Utilization Management & Medical Necessity * Conduct admission, continued-stay, and discharge reviews for all patients based on: * InterQual ® , MCG, or payer-specific medical necessity criteria.
Utilization Management & Medical Necessity * Conduct admission, continued-stay, and discharge reviews for all patients based on: * InterQual ® , MCG, or payer-specific medical necessity criteria.
The Utilization Review RN is responsible for ensuring that all behavioral health patients receive ... Utilization Management & Medical Necessity * Conduct admission, continued-stay, and discharge ...
The Utilization Review RN is responsible for ensuring that all behavioral health patients receive ... Utilization Management & Medical Necessity * Conduct admission, continued-stay, and discharge ...
Overview Under the supervision of the Director of Utilization Management, the Clinical Quality and Utilization Review Specialist performs a dual role encompassing utilization management and peer ...
Overview Under the supervision of the Director of Utilization Management, the Clinical Quality and Utilization Review Specialist performs a dual role encompassing utilization management and peer ...
Overview Under the supervision of the Director of Utilization Management, the Clinical Quality and Utilization Review Specialist performs a dual role encompassing utilization management and peer ...
Overview Under the supervision of the Director of Utilization Management, the Clinical Quality and Utilization Review Specialist performs a dual role encompassing utilization management and peer ...
Under the supervision of the Director of Utilization Management, the Clinical Quality and Utilization Review Specialist performs a dual role encompassing utilization management and peer review. This ...
Under the supervision of the Director of Utilization Management, the Clinical Quality and Utilization Review Specialist performs a dual role encompassing utilization management and peer review. This ...
Utilization Review RN
Houston, TX · On-site
Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical ... Every day, you will meticulously review medical records, authorize services, and prepare cases for ...
Utilization Review RN
Houston, TX · On-site
Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical ... Every day, you will meticulously review medical records, authorize services, and prepare cases for ...
As our Utilization Management Professional, you will be a critical guardian of healthcare ... Every day, you will meticulously review medical records, authorize services, and prepare cases for ...
As our Utilization Management Professional, you will be a critical guardian of healthcare ... Every day, you will meticulously review medical records, authorize services, and prepare cases for ...
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?
| 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 Texas? The most popular types of Optum Utilization Review jobs in Texas are:
What are popular job titles related to Manager Optum Utilization Review jobs in Texas? For Manager Optum Utilization Review jobs in Texas, the most frequently searched job titles are:
- Utilization Management Nurse
- Utilization Review Physician
- Remote Medical Record Review Nurse
- Cvs Health Utilization Management
- Non Exempt No Experience Utilization Management Nurse
- Remote Case Reviewer
- Weekend Physician Advisor Utilization Review
- Navihealth Clinical Review Coordinator
- Optum Clinical Claim Review Nurse
- Remote Telephonic Nurse
What job categories do people searching Manager Optum Utilization Review jobs in Texas look for? The top searched job categories for Manager Optum Utilization Review jobs in Texas are:
- Cigna Utilization Review Remote
- Utilization Review Clinician
- Director Optum Utilization Review
- Remote Occupational Therapy Utilization Review
- Utilization Review Coordinator
- Aetna Utilization Review Nurse
- Nurse Practitioner Utilization Review
- Temporary Aetna Utilization Review Nurse
- Commission Anthem Utilization Review
- Part Time Utilization Review Manager
What cities in Texas are hiring for Manager Optum Utilization Review jobs? Cities in Texas with the most Manager Optum Utilization Review job openings:
Part-time
Re-posted 23 days ago
Medical Center Health System rating
8.4
Based on 33 frontline employees who took The Breakroom Quiz
24th of 887 rated healthcare providers
Job description
Position Summary:
Assists UM Department with utilization review processes, including the collection and analysis of various computer-based data related to Utilization Review, Care Coordination, and Commercial Insurance.
Qualifications:
A. Education:
Must have a high school diploma or equivalent.
B. Training and Experience:
Must have a minimum of one-year work experience in an acute care medical facility.
C. Job Knowledge:
Familiar with medical terminology, utilization review, community resource a plus. Basic computer skills required. Be able to communicate effectively verbally and in writing.
Unusual Physical Demands and Working Conditions:
Should be familiar with healthcare operations. Experience with the collection and management of data preferred. Familiar with medical terminology, utilization review, and/or medical insurance preferred.
Ability to communicate effectively and professionally, both verbally and in writing.
Assists UM Department with utilization review processes, including the collection and analysis of various computer-based data related to Utilization Review, Care Coordination, and Commercial Insurance.
Qualifications:
A. Education:
Must have a high school diploma or equivalent.
B. Training and Experience:
Must have a minimum of one-year work experience in an acute care medical facility.
C. Job Knowledge:
Familiar with medical terminology, utilization review, community resource a plus. Basic computer skills required. Be able to communicate effectively verbally and in writing.
Unusual Physical Demands and Working Conditions:
Should be familiar with healthcare operations. Experience with the collection and management of data preferred. Familiar with medical terminology, utilization review, and/or medical insurance preferred.
Ability to communicate effectively and professionally, both verbally and in writing.
What Medical Center Health System employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Medical Center Health System
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Odessa, TX, US
Year founded
1949