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Director Optum Health Utilization Review Jobs (NOW HIRING)

Mindful Health

Utilization Review Specialist

$25 - $30/hr

Utilization Review Specialist Mindful Health is a fast-growing company with the goal of providing an intentionally different approach to mental health and well-being. We are a combination of bricks ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Oakland Park, FL · On-site

FLBHC provides innovative behavioral health treatment and academic services to children ... The Director of Utilization Management is also responsible for ensuring that the utilization review ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Oakland Park, FL · On-site

FLBHC provides innovative behavioral health treatment and academic services to children ... The Director of Utilization Management is also responsible for ensuring that the utilization review ...

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How much do director optum health utilization review jobs pay per hour?

As of Jun 14, 2026, the average hourly pay for director optum health utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is the difference between Director Optum Health Utilization Review vs Utilization Review Manager?

AspectDirector Optum Health Utilization ReviewUtilization Review Manager
CertificationsTypically requires RN, CPC, or other healthcare-related certificationsOften requires RN or healthcare management certifications
Work EnvironmentCorporate healthcare setting, primarily in insurance or health services companiesHealthcare facilities or insurance companies managing patient care reviews
ResponsibilitiesOversees utilization review processes, policy development, and team managementManages daily review operations, staff supervision, and compliance

The main difference is that the Director Optum Health Utilization Review typically holds a higher leadership role with strategic responsibilities, while the Utilization Review Manager focuses more on daily operations and team management within the utilization review process.

What cities are hiring for Director Optum Health Utilization Review jobs? Cities with the most Director Optum Health Utilization Review job openings:
What are the most commonly searched types of Optum Health Utilization Review jobs? The most popular types of Optum Health Utilization Review jobs are:
What states have the most Director Optum Health Utilization Review jobs? States with the most job openings for Director Optum Health Utilization Review jobs include:
Director Optum Health Utilization Review jobs near you
Manager, Utilization Review (5052)

Manager, Utilization Review (5052)

Regional One Health

Memphis, TN • On-site

Full-time

Posted 3 days ago

Regional One Health rating

6.4

Company rating: 6.4 out of 10

Based on 33 frontline employees who took The Breakroom Quiz

633rd of 872 rated healthcare providers

Job description

Regional One Health is currently seeking a Manager, Utilization Review
A Brief Overview
The Manager, Utilization Review manages the daily operations of the Utilization Review Department and is responsible for overseeing and coordinating utilization review processes within Regional One Health. Utilization Review activities include inpatient, observation, outpatient in a bed, ambulatory surgery, and Point-of-Entry Utilization review/case management activities. This role is crucial in ensuring appropriate utilization of healthcare resources while maintaining high-quality patient care. The Utilization Review Manager works collaboratively with medical and hospital staff to efficiently support and integrate utilization review activities.
What you will do
  • Reports to the Sr. Director on department activities, market changes, and operational opportunities, presenting action plans as necessary.
  • Establishes and maintains an organizational structure and staffing to meet departmental and organizational goals.
  • Develops and implements utilization review policies and procedures in compliance with regulatory requirements and industry best practices.
  • Stay current on changes in healthcare regulations, laws, and policies affecting utilization review.
  • Supervises the utilization review staff, including case managers (Point of Entry) and the utilization review team.
  • Oversees the submission of utilization activities, including ensuring timely and accurate submission of medical necessity reviews, clinical documentation to providers for authorization and concurrent review, and planned surgery authorizations.
  • Conducts periodic reviews of medical records to assess the appropriateness of care and services provided.
  • Assists in developing and managing department budgets and implementing cost containment measures as needed.
  • Participates in quality improvement initiatives, including patient satisfaction surveys and process improvement projects.
  • Communicates utilization review findings and recommendations to hospital administration, medical staff, and other stakeholders.
  • Ensures compliance with best practices and standards related to utilization review metrics and data collection.
  • Oversees staff competencies, training, and development to maintain a highly skilled workforce.
  • Supports leadership in setting department goals, monitoring program effectiveness, and making necessary adjustments based on utilization statistics and cost-benefit analysis.
  • Leads quality improvement initiatives, including audits and mock inspections, to maintain compliance and operational excellence.
  • Ensures timely submission of departmental reports, highlighting findings, recommendations, and action plans.
  • Encourages professional growth and continuous education among team members.

  • Bachelor's Degree in Healthcare Administration or Management Preferred
  • Bachelor's Degree in Nursing (BSN) Preferred
  • Master's Degree Strongly preferred
  • Registered Nurse (RN) Required
  • Minimum 5 years experience Five (5) years' progressively responsible related experience is required, preferably within a healthcare environment. Required

Physical Demands
  • Standing - Occasionally
  • Walking - Occasionally
  • Sitting - Constantly
  • Lifting - Rarely
  • Carrying - Rarely
  • Pushing - Rarely
  • Pulling - Rarely
  • Climbing - Rarely
  • Balancing - Rarely
  • Stooping - Rarely
  • Kneeling - Rarely
  • Crouching - Rarely
  • Crawling - Rarely
  • Reaching - Rarely
  • Handling - Occasionally
  • Grasping - Occasionally
  • Feeling - Rarely
  • Talking - Constantly
  • Hearing - Constantly
  • Repetitive Motions - Frequently
  • Eye/Hand/Foot Coordination - Frequently

Regional One Health is an equal opportunity employer.

What Regional One Health employees say

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