ZipRecruiter

Log In

2

Remote Optum Utilization Review Jobs in Michigan

Pharmacy Careers

Appeals Pharmacist (Remote)

Ypsilanti, MI · On-site +1

$51.75 - $63/hr

Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Detroit, MI · On-site +1

$52.50 - $63.75/hr

Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

Curbee

Dealer Success Manager

Detroit, MI · On-site +1

$90K - $115K/yr

S. (Mobile and Remote Service). With Curbee., it's simple: dealerships send the right van to the ... Perform MBRs and QBRs, track key metrics like appointments, utilization, and review results on a ...

OpTech

Senior Health Care Data Analyst (SAS / SQL)

Detroit, MI · On-site +1

$78K - $99K/yr

... remote work options, growth opportunities, 401K and competitive pay. Apply today! To view our ... This position operates within broad objectives to ensure optimum utilization of manpower and budget

New

next page

Showing results 1-20

All JobsOptum Utilization Review JobsRemote Optum Utilization Review JobsRemote Optum Utilization Review Jobs in Michigan

Remote Optum Utilization Review information

What is the difference between Remote Optum Utilization Review vs Remote UnitedHealthcare Utilization Review?

AspectRemote Optum Utilization ReviewRemote UnitedHealthcare Utilization Review
CredentialsLicenses in relevant states, certifications like CCM or CRC often preferredLicenses in relevant states, certifications like CCM or CRC often preferred
Work EnvironmentRemote, home-based with flexible hoursRemote, home-based with flexible hours
Employer & IndustryOptum, healthcare services and utilization managementUnitedHealthcare, health insurance and utilization review

Both roles involve reviewing healthcare claims and authorizations remotely, requiring similar credentials and work environments. The main difference lies in the employer and specific healthcare focus: Optum specializes in healthcare services and utilization management, while UnitedHealthcare focuses on health insurance and claims review. Candidates often compare these roles to determine the best fit based on employer and industry specialization.

How does a Remote Optum Utilization Review nurse typically collaborate with multidisciplinary teams while working from home?

As a Remote Optum Utilization Review nurse, collaboration with multidisciplinary teams is primarily conducted through secure digital platforms, including video calls, emails, and electronic health record systems. You’ll regularly communicate with physicians, social workers, case managers, and other healthcare providers to review patient cases, coordinate care plans, and ensure compliance with clinical guidelines. Despite working remotely, maintaining clear and timely communication is essential for effective patient advocacy and decision-making. Team meetings and case discussions are scheduled virtually, fostering a supportive environment and ensuring you stay connected to the broader healthcare team.

What is a Remote Optum Utilization Review position?

A Remote Optum Utilization Review position involves working for Optum, a healthcare services company, to evaluate medical records and determine the necessity and appropriateness of healthcare services. Employees in this role review clinical documentation to ensure that treatments meet established guidelines and help to manage healthcare costs while ensuring patient care is not compromised. The position is remote, meaning you can work from home or another location outside of a traditional office. Utilization review professionals often interact with healthcare providers, insurance companies, and patients, using their clinical expertise to make informed decisions.

What are the key skills and qualifications needed to thrive as a Remote Optum Utilization Review Nurse, and why are they important?

To thrive as a Remote Optum Utilization Review Nurse, you need a current RN license, strong clinical judgment, knowledge of utilization management, and experience in case review or discharge planning. Proficiency with medical review software, electronic health records, and familiarity with UM guidelines such as InterQual or Milliman is typically required. Exceptional communication, attention to detail, and critical thinking are vital soft skills for effective collaboration and decision-making in a remote environment. These skills ensure accurate assessments, regulatory compliance, and optimal patient outcomes while maintaining efficiency in a virtual workflow.
What are the most commonly searched types of Optum Utilization Review jobs in Michigan? The most popular types of Optum Utilization Review jobs in Michigan are:
What are popular job titles related to Remote Optum Utilization Review jobs in Michigan? For Remote Optum Utilization Review jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Remote Optum Utilization Review jobs in Michigan look for? The top searched job categories for Remote Optum Utilization Review jobs in Michigan are:
What cities in Michigan are hiring for Remote Optum Utilization Review jobs? Cities in Michigan with the most Remote Optum Utilization Review job openings:
Remote Optum Utilization Review jobs near you
Utilization Review Assistant- Remote

Utilization Review Assistant- Remote

Hurley Medical Center

Flint, MI • On-site, Remote

Full-time

Posted 14 days ago

Hurley Medical Center rating

6.9

Company rating: 6.9 out of 10

Based on 27 frontline employees who took The Breakroom Quiz

528th of 998 rated hospitals

Job description

Job Description
This position will assist in the coordination of all activities related to insurance authorizations process for the Patient Access Utilization Review (UR) department. Activities may consist of collaborating with various medical staff and Medical Center personnel, participating in non-clinical appeals process, obtaining status updates on all outstanding appeals, monitoring and tracking of all financial activities related to the UR team. Participates in quality management and continuous quality improvement activities. Perform all job duties and responsibilities in a courteous and customer-focused manner according to the Hurley Family Standards of Behavior. Works under the direction of the Director of Patient Access or designee who reviews work for effectiveness and compliance with established standards, policies, and procedures.
Responsibilities
  1. Perform necessary authorization-related tasks in an accurate and timely manner. This includes utilization of the Epic EMR system efficiently and effectively and providing sufficient and clear documentation of all actions taken.
  2. Assist in the initial authorization approval process by communicating with various payers and other internal Medical Center personnel and submitting pertinent documentation to the payers for approval consideration.
  3. Assist in submitting concurrent and retrospective reviews to appropriate payers. This may require following up with physicians and other health care providers to review admissions and continued stays not meeting criteria.
  4. Stay abreast of health care benefit inclusions and exclusions for all financial classes, benefit changes, review requirements, and other pertinent regulations influencing the Medical Center.
  5. Assist with appeals of denied days by third-party reviewers throughout each stage of available reconsideration/appeal mechanisms.
  6. Review charts for instances of over/under utilization of ancillary services to ensure optimum quality of care and maximum reimbursement.
  7. Collaborate with the Patient Access/Registration, Medical Records, Billing teams, and other hospital areas to ensure post discharge completion of all information necessary to generate timely billing.
  8. Assist in drafting letters to third-party review entities and medical staff members and working with the Utilization Review Coordinators for approval and finalization of such letters.
  9. Assist in identification, development, and implementation of new procedures designed to increase operating efficiency.
  10. Review level of care for patients (with UR Coordinators and medical staff approval) regarding inpatient, observation, and outpatient care and relate this information to the Revenue Cycle teams for billing purposes.
  11. Maintain all primary assignments (based on financial goals assigned to the UR department). This consists of working on Discharge Not Billed (DNB), Claim Edits, and Stop Bill work queues or reports to accomplish timely accounts resolution.
  12. Perform other related duties as required/assigned. Utilizes new improvements and/or technologies that relate to job assignment.

Qualifications
  • Associate's degree in healthcare or related field required (Bachelor's degree preferred).
  • Two (2) years of healthcare experience in authorizations, coding, patient registration, billing, or utilization review.
  • Knowledge of hospital patient care admission processes and third party payer utilization requirements.
  • Strong background and knowledge of payer authorizations and referrals.
  • Ability to communicate effectively in oral and written modes.
  • Ability to interact courteously and effectively with all levels of the Medical Center staff, patients, medical staff, external agency representatives, and the public.

NOTE: If the incumbent is skillfully prepared and actively pursuing a degree, they will be required to obtain minimally an Associate's degree within one (1) year of accepting the position.

What Hurley Medical Center employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply