Optum

Compensation

Full Description

Job Title: Utilization Management Representative Company Overview: Optum is a leading health services and innovation company dedicated to improving the health system and delivering better care to patients. As part of the UnitedHealth Group family, Optum combines technology, data, and expertise to transform healthcare delivery and management. Our Southern California Physicians Managed Care Services division focuses on providing exceptional managed care solutions to improve patient outcomes and client satisfaction. Role Overview: As a Utilization Management Representative, you will play a critical role in evaluating and managing healthcare services to ensure appropriate care delivery. You will work closely with healthcare providers, patients, and internal teams to review medical necessity and support efficient utilization of resources. What You'll Do: - You will review and assess medical records and treatment plans to determine the necessity and appropriateness of care. - You will collaborate with healthcare providers to obtain additional information and clarify treatment details. - You will communicate decisions regarding utilization management to providers and patients clearly and professionally. - You will ensure compliance with regulatory requirements and company policies in all utilization management activities. - You will document all case reviews and decisions accurately in the system. - You will participate in quality improvement initiatives to enhance service delivery. - You will stay current with healthcare regulations, policies, and best practices related to utilization management. - You will support the team in meeting performance goals and client expectations. What You Bring: - Minimum of 2 years experience in utilization management, case management, or a related healthcare role. - Strong knowledge of medical terminology, healthcare regulations, and managed care processes. - Excellent communication and interpersonal skills to interact effectively with providers and patients. - Proficiency in electronic medical records (EMR) systems and Microsoft Office Suite. - Ability to analyze clinical information and make sound decisions based on guidelines. - Detail-oriented with strong organizational and documentation skills. Bonus Points If You Have: - Certification in Case Management (CCM) or Utilization Review (URAC) credentials. - Experience working in a managed care or insurance environment. - Familiarity with Southern California healthcare providers and systems. - Bilingual skills, especially in Spanish, to support diverse patient populations. What We Offer: - We offer competitive salary and comprehensive benefits including health, dental, and vision insurance. - We offer opportunities for professional development and career advancement within Optum. - We offer a supportive and inclusive work environment that values diversity. - We offer flexible work schedules and remote work options to support work-life balance. - We offer employee wellness programs and resources to promote your health and well-being. Ready to Apply? To join our team as a Utilization Management Representative, please submit your resume and cover letter through the Optum careers website. We look forward to reviewing your application and exploring how you can contribute to our mission of improving healthcare delivery.