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Optum Utilization Review Jobs in Indiana (NOW HIRING)

Specialty Pharmacist Explore opportunities with CPS, part of the Optum family of businesses. We're ... Review and manage specialty medication therapies for complex, chronic, or high-cost conditions

Review and manage specialty medication therapies for complex, chronic, or high-cost conditions ... Oversee prior authorizations and utilization management, ensuring compliance with payer and program ...

Optum Utilization Review information

What is an Optum Utilization Review?

An Optum Utilization Review job involves assessing medical treatments and services to ensure they are medically necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this role review patient cases, collaborate with healthcare providers, and apply clinical criteria to determine coverage approvals. They help optimize patient care while managing healthcare costs. Typically, these positions require a background in nursing or healthcare and knowledge of utilization management policies.

What does an Optum Utilization Review do?

In an Optum Utilization Review position, you can expect a mix of reviewing patient medical records, communicating with healthcare providers to gather additional information, and making decisions on the medical necessity and appropriateness of services. The role often involves using clinical guidelines and established protocols to ensure coverage aligns with insurance policies, as well as accurate documentation of findings and recommendations. You'll collaborate with physicians, other case managers, and sometimes directly with members, in a structured yet dynamic environment. While much of the work may be independent and computer-based, teamwork and communication are essential to coordinate care and resolve complex cases.

What are the key skills and qualifications needed to thrive in an Optum Utilization Review?

To succeed in an Optum Utilization Review role, candidates typically need a clinical background such as a registered nurse (RN) or social worker (LCSW), along with experience in case management and knowledge of utilization management principles. Familiarity with medical review software, electronic health records (EHRs), and utilization management platforms like InterQual or Milliman is often expected, as well as active state licensure or relevant certifications (e.g., CCM). Strong analytical thinking, attention to detail, and effective communication are critical soft skills for collaborating with healthcare providers and internal teams. These competencies are vital to ensure appropriate use of healthcare resources, compliance with regulations, and optimal patient outcomes.

What are the most commonly searched types of Optum Utilization Review jobs in Indiana?

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

Infographic showing various Optum Utilization Review job openings in Indiana as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Staff Pharmacist Per Diem

Winamac, IN • On-site

Genoa Telepsychiatry
Offices of Mental Health Practitioners • 51 - 200 employees

$44 - $79/hr

Other

Retirement

Posted 4 days ago


Job description

Explore Opportunities With Cps

CPS, part of the Optum family of businesses, is dedicated to crafting and delivering innovative hospital and pharmacy solutions for better patient outcomes across the entire continuum of care. With CPS, you'll work alongside our team of more than 2,500 pharmacy professionals, technology experts, and industry leaders to drive superior financial, clinical, and operational performance for health systems nationwide. Ready to help shape the future of pharmacy and hospital solutions? Join us and discover the meaning behind Caring. Connecting. Growing together.

Primary Responsibilities:

  • Review and manage specialty medication therapies for complex, chronic, or high-cost conditions
  • Provide patient education and counseling, focusing on adherence, administration, side effects, and outcomes
  • Coordinate care with providers, payers, and manufacturers to ensure therapy access and continuity
  • Oversee prior authorizations and utilization management, ensuring compliance with payer and program requirements
  • Monitor effectiveness and safety of therapy, including lab values, adherence metrics, and patient-reported outcomes
  • Ensure compliance with REMS and accreditation standards, including documentation and reporting requirements
  • Support quality initiatives and outcomes reporting, meeting specialty pharmacy performance and regulatory metrics

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • Bachelor of Pharmacy or PharmD degree
  • Current, unrestricted Pharmacist license for the state in which this position is located

Preferred Qualification:

  • 1+ years of experience as a Pharmacist

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The hourly pay for this role will range from $44.00 - $79.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.