UTILIZATION REVIEW RN
Seymour, IN · On-site
Graduate of accredited school of nursing (BSN Preferred) Preferred: Bachelors Degree in Nursing ... Utilization Review and Medical Necessity * Concurrent Review and Length of Stay Management
UTILIZATION REVIEW RN
Seymour, IN · On-site
Graduate of accredited school of nursing (BSN Preferred) Preferred: Bachelors Degree in Nursing ... Utilization Review and Medical Necessity * Concurrent Review and Length of Stay Management
Registered Nurse Utilization Review
Carmel, IN · On-site +1
$50 - $52/hr
Minimum of 3 years hospital based bedside nursing experience in Med/Surg, ER, or critical care * Utilization Review OR Case Management experience required * Must live locally in Indiana Life at ...
Registered Nurse Utilization Review
Carmel, IN · On-site +1
$50 - $52/hr
Minimum of 3 years hospital based bedside nursing experience in Med/Surg, ER, or critical care * Utilization Review OR Case Management experience required * Must live locally in Indiana Life at ...
Registered Nurse Utilization Review
Carmel, IN · On-site
$84K/yr
Minimum of 3 years hospital based bedside nursing experience in Med/Surg, ER, or critical care * Utilization Review OR Case Management experience required * Must live locally in Indiana Equal ...
New
Registered Nurse Utilization Review
Carmel, IN · On-site
$84K/yr
Minimum of 3 years hospital based bedside nursing experience in Med/Surg, ER, or critical care * Utilization Review OR Case Management experience required * Must live locally in Indiana Equal ...
New
UTILIZATION REVIEW RN
Seymour, IN · On-site
Graduate of accredited school of nursing (BSN Preferred) Preferred: Bachelors Degree in Nursing ... DUTIES 1. Utilization Review and Medical Necessity 2. Concurrent Review and Length of Stay ...
UTILIZATION REVIEW RN
Seymour, IN · On-site
Graduate of accredited school of nursing (BSN Preferred) Preferred: Bachelors Degree in Nursing ... DUTIES 1. Utilization Review and Medical Necessity 2. Concurrent Review and Length of Stay ...
The Utilization Review Specialist serves as a key resource in minimizing prescription delays ... Collaborate with prescribers, nurses, pharmacists, and clinic staff to obtain missing clinical ...
The Utilization Review Specialist serves as a key resource in minimizing prescription delays ... Collaborate with prescribers, nurses, pharmacists, and clinic staff to obtain missing clinical ...
The Utilization Review Specialist serves as a key resource in minimizing prescription delays ... Collaborate with prescribers, nurses, pharmacists, and clinic staff to obtain missing clinical ...
The Utilization Review Specialist serves as a key resource in minimizing prescription delays ... Collaborate with prescribers, nurses, pharmacists, and clinic staff to obtain missing clinical ...
The Utilization Review Specialist serves as a key resource in minimizing prescription delays ... Collaborate with prescribers, nurses, pharmacists, and clinic staff to obtain missing clinical ...
The Utilization Review Specialist serves as a key resource in minimizing prescription delays ... Collaborate with prescribers, nurses, pharmacists, and clinic staff to obtain missing clinical ...
... Nurse in the state of Indiana. Must be current in BLS. Experience: Two years of hospital clinical experience. Knowledge of medical standards of care, state and federal utilization review laws, and ...
... Nurse in the state of Indiana. Must be current in BLS. Experience: Two years of hospital clinical experience. Knowledge of medical standards of care, state and federal utilization review laws, and ...
... Nurse in the state of Indiana. Must be current in BLS. Experience: Two years of hospital clinical experience. Knowledge of medical standards of care, state and federal utilization review laws, and ...
New
... Nurse in the state of Indiana. Must be current in BLS. Experience: Two years of hospital clinical experience. Knowledge of medical standards of care, state and federal utilization review laws, and ...
New
Utilization Review RN
Indianapolis, IN · On-site
$30 - $34/hr
Expected to review 20 cases a day with a 95% accuracy rate. Responsible for collaborating with ... Must have clear and active RN license in the state of IN * 2 years of experience in a acute care ...
Utilization Review RN
Indianapolis, IN · On-site
$30 - $34/hr
Expected to review 20 cases a day with a 95% accuracy rate. Responsible for collaborating with ... Must have clear and active RN license in the state of IN * 2 years of experience in a acute care ...
Utilization Review RN
Indianapolis, IN · On-site
... reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. Qualifications * Must have clear and active RN license in the state of IN * AS ...
Utilization Review RN
Indianapolis, IN · On-site
... reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. Qualifications * Must have clear and active RN license in the state of IN * AS ...
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
Cooperates and maintains good rapport with nursing staff, medical staff, and other departments ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
Cooperates and maintains good rapport with nursing staff, medical staff, and other departments ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
... thorough review of the total resources available to patient pre and post-discharge from ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
... thorough review of the total resources available to patient pre and post-discharge from ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
... thorough review of the total resources available to patient pre and post-discharge from ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
... thorough review of the total resources available to patient pre and post-discharge from ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
Cooperates and maintains good rapport with nursing staff, medical staff, and other departments ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
Cooperates and maintains good rapport with nursing staff, medical staff, and other departments ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
... thorough review of the total resources available to patient pre and post-discharge from ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
... thorough review of the total resources available to patient pre and post-discharge from ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
... thorough review of the total resources available to patient pre and post-discharge from ... N experience preferredHoursMonday - Friday (8:30am-5:00pm)This position is on-site at RHI The ...
Quick apply
... thorough review of the total resources available to patient pre and post-discharge from ... N experience preferredHoursMonday - Friday (8:30am-5:00pm)This position is on-site at RHI The ...
... oversees utilization management including, but not limited to: utilization review, case ... Must have Registered Nurse license or Master's Degree. Experience: 5-7 yrs acute inpatient ...
... oversees utilization management including, but not limited to: utilization review, case ... Must have Registered Nurse license or Master's Degree. Experience: 5-7 yrs acute inpatient ...
Reviewing patient admission clinical information using clinical criteria and guidelines available ... Facilitating discharge planning by working closely with Nurses and Clinical Social Workers and/or ...
Reviewing patient admission clinical information using clinical criteria and guidelines available ... Facilitating discharge planning by working closely with Nurses and Clinical Social Workers and/or ...
Optum Utilization Review Nurse information
What does an Optum Utilization Review Nurse do?
An Optum Utilization Review Nurse is responsible for reviewing medical records and patient cases to ensure that healthcare services provided are medically necessary and compliant with insurance guidelines. They evaluate treatment plans, collaborate with healthcare providers, and help determine coverage decisions for patients. By assessing the appropriateness of care, they help manage healthcare costs and improve patient outcomes. Their work involves communication with physicians, patients, and insurance representatives to ensure efficient and effective care delivery.
What are the key skills and qualifications needed to thrive as an Optum Utilization Review Nurse?
To thrive as an Optum Utilization Review Nurse, you need strong clinical assessment skills, a current RN license, and experience in case management or utilization review. Familiarity with clinical documentation systems, InterQual or Milliman Care Guidelines, and managed care regulations is typically required. Attention to detail, critical thinking, and effective communication are crucial soft skills for this role. These competencies are vital to ensure appropriate care decisions, regulatory compliance, and collaboration with interdisciplinary teams for optimal patient outcomes.
How does an Optum Utilization Review Nurse typically collaborate with physicians and other healthcare professionals during the review process?
As an Optum Utilization Review Nurse, you will frequently interact with physicians, case managers, and other healthcare providers to assess the medical necessity and appropriateness of patient care. This collaboration often involves reviewing clinical documentation, participating in multidisciplinary meetings, and communicating findings or recommendations to ensure quality and cost-effective care. Building strong professional relationships and maintaining clear, respectful communication are key to facilitating smooth care transitions and achieving optimal patient outcomes. This collaborative approach helps ensure that all parties are aligned with evidence-based guidelines and organizational policies.
What is the difference between Optum Utilization Review Nurse vs Optum Case Manager?
| Aspect | Optum Utilization Review Nurse | Optum Case Manager |
|---|---|---|
| Credentials | RN license, certifications in case management or utilization review often preferred | RN license, case management certification often preferred |
| Work Environment | Reviewing medical records, assessing insurance claims, working in healthcare or insurance settings | Coordinating patient care, managing cases, working in healthcare or insurance settings |
| Employer & Industry | Health insurance companies, healthcare providers, utilization review departments | Health insurance companies, healthcare organizations, patient advocacy |
Optum Utilization Review Nurses primarily evaluate medical necessity and approve or deny insurance claims, focusing on utilization review. In contrast, Optum Case Managers coordinate patient care, develop treatment plans, and support patient needs. Both roles require nursing credentials and work within healthcare or insurance environments, but their core responsibilities differ in focus and scope.
What are popular job titles related to Optum Utilization Review Nurse jobs in Indiana?
For Optum Utilization Review Nurse jobs in Indiana, the most frequently searched job titles are:
- Remote Utilization Review Rn
- No Experience Utilization Review Nurse
- Per Diem Chart Review Nurse
- Night Utilization Review Nurse
- Registered Nurse Utilization Review
- Clinical Review Nurse Remote
- Remote Utilization Review Social Worker
- Remote Medical Record Review Nurse
- Remote Medical Review Nurse
- Oasis Review Nurse
What job categories do people searching Optum Utilization Review Nurse jobs in Indiana look for?
The top searched job categories for Optum Utilization Review Nurse jobs in Indiana are:
- Lpn Utilization Review Work From Home
- Weekend Utilization Review
- Therapy Utilization Review
- From Home Anthem Utilization Review Nurse
- Remote Preservice Review Nurse
- Anthem Utilization Review Nurse
- Case Manager Utilization Review Nurse
- Remote Optum Utilization Review
- Remote Utilization Review
- Remote Utilization Review Nurse Practitioner
What cities in Indiana are hiring for Optum Utilization Review Nurse jobs?
Cities in Indiana with the most Optum Utilization Review Nurse job openings:
Schneck Medical Center rating
7.2
Based on 14 frontline employees who took The Breakroom Quiz
424th of 1,064 rated hospitals
Job description
Job Details
SALARY / 8:00am - 5:00pm / with on-call, weekend, & holiday rotation required
ELIGIBLE FOR $2,000 SIGN-ON BONUS!
JOB REQUIREMENTS EDUCATION Minimum: Graduate of accredited school of nursing (BSN Preferred) Preferred: Bachelors Degree in Nursing with case management certification
LICENSE/CERTIFICATION Licensed RN in State of Indiana. Certification plan in place within 24 months of hire.
EXPERIENCE Minimum: 2-3 years of acute care clinical experience Preferred: 3-5 years of acute care clinical experience with strong knowledge of medical necessity criteria and payer requirements
JOB DUTIES
- Utilization Review and Medical Necessity
- Concurrent Review and Length of Stay Management
- Retrospective Review
- Payer Communication & Authorization
- Denials Management and Appeals
Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
What Schneck Medical Center employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Schneck Medical Center
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Seymour, IN, US
Year founded
1911