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Director Remote Utilization Review Jobs in Oklahoma

Harris

Remote Care Management - CMA

Kansas, OK · Remote

Chart Review: 8 min Outreach Attempts: 6 min Actual Call: 11 min Care Coordination: 9 min Total ... Self-directed. Ability to prioritize responsibilities. Demonstrated time management skills. * Clear ...

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Director Remote Utilization Review information

What is a director of remote utilization review?

A Director of Remote Utilization Review is a healthcare leader responsible for overseeing teams that assess the necessity, appropriateness, and efficiency of medical services, typically from a remote or virtual environment. This role ensures compliance with regulatory guidelines, optimizes resource use, and helps manage healthcare costs while maintaining quality patient care. Directors collaborate with physicians, nurses, and insurance providers to review clinical cases and develop utilization review strategies. They also monitor performance metrics and implement process improvements for remote teams.

How does a director of remote utilization review typically collaborate with clinical and administrative teams to ensure effective patient care management?

A Director of Remote Utilization Review plays a pivotal role in bridging clinical staff, case managers, and administrative teams to optimize patient care and resource utilization. This is often achieved through regular virtual meetings, data sharing, and cross-departmental strategy sessions to review utilization trends and address barriers to care. The director ensures that remote teams adhere to regulatory standards and organizational goals, fostering open communication to streamline workflows and resolve complex cases efficiently. Successful collaboration enhances patient outcomes, reduces unnecessary costs, and maintains compliance, all while supporting a positive remote team environment.

What are the key skills and qualifications needed to thrive as a director of remote utilization review, and why are they important?

To thrive as a Director of Remote Utilization Review, you need in-depth knowledge of healthcare regulations, utilization management processes, and a relevant clinical background, typically supported by an RN or other clinical licensure and experience in case management. Familiarity with utilization review software, electronic health records (EHR), and certifications such as CCM or UM are often required. Leadership, analytical thinking, and strong communication skills are vital for guiding teams and collaborating with stakeholders. These skills ensure effective oversight of remote teams, regulatory compliance, and optimal patient care outcomes.

What is the difference between Director Remote Utilization Review vs Utilization Review Nurse?

AspectDirector Remote Utilization ReviewUtilization Review Nurse
CredentialsTypically requires a nursing license, advanced degree, and management experienceRegistered Nurse (RN) license, relevant clinical experience
Work EnvironmentOversees teams remotely, strategic planning, policy developmentConducts patient reviews, collaborates with healthcare providers, often remote or onsite
Employer & Industry UsageHealth insurance companies, managed care organizationsHospitals, insurance companies, healthcare facilities

The main difference is that the Director Remote Utilization Review focuses on managing teams and policies remotely, while the Utilization Review Nurse performs clinical reviews directly related to patient care. The director has a broader strategic role, whereas the nurse role is more clinical and operational.

What are the most commonly searched types of Remote Utilization Review jobs in Oklahoma?

The most popular types of Remote Utilization Review jobs in Oklahoma are:

Director Remote Utilization Review jobs near you
Infographic showing various Director Remote Utilization Review job openings in Oklahoma as of July 2026, with employment types broken down into 1% As Needed, 86% Full Time, 11% Part Time, 1% Temporary, and 1% Contract. Highlights an 83% Physical, 13% Hybrid, and 4% Remote job distribution.

Health Services Coordinator (52451)

GLOBALHEALTH HOLDINGS LLC

Oklahoma City, OK • Remote

Full-time

Medical

Posted 8 days ago

Job description

WHO WE ARE:

    GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.

    WHO YOU ARE:

    This position, under the direction of the Supervisor, Heath Services Coordination, provides administrative support for utilization review, health education and care management. This includes data entry, communication with members, providers, and vendors for education and information gathering. 

    ESSENTIAL JOB FUNCTIONS:

    • Following Medicare/Medicaid Timelines for Notification to Provider/Members to meet department goals and requirements.
    • Verbal and/or written outreach to members and/or providers to provide updates on referral request status, reasoning behind decisions, and provide accurate information.
    • Daily Mail fulfillment – faxes to provide notification to provider or member of decisions,
    • Coordination of services for members, including community resources and collaboration with assigned case manager
    • Develop and maintain resources related to the department.
    • Support departmental initiatives.
    • Identify and report process improvement opportunities.
    • Manage and document member and provider calls.
    • Enter authorization requests in the medical management systems.
    • Process member notifications
    • Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
    • Performs other duties as assigned.

    EDUCATION AND EXPERIENCE:

    • High School diploma or equivalent and two years of data entry experience in an administrative support position required.
    • Experience working with medical records preferred.
    • Experience working in managed care or utilization management environment preferred.

    KNOWLEDGE, SKILLS AND ABILITIES:

    • Strong attention to detail
    • Excellent communication skills, Clear and effective written and verbal
    • Organization and time management skills, including ability to prioritize tasks.
    • Strong working knowledge of Microsoft Word, Visio, Excel and Power Point.
    • Strategic and Analytic thinking, Lean Six Sigma Green belt or Black belt- preferred.
    • Ability to work independently and with a group.
    • Self-motivated
    • Excellent customer service skills
    • Demonstrated knowledge of managing the use of a SharePoint site or equivalent application

    WORK ENVIRONMENT:

    Current work environment is remote; however, some state exclusions apply. Must have access to a reliable and secured internet connection source. Work environment must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. This position will also be required to use reasonable and necessary safeguards to protect GlobalHealth records from unauthorized access, disclosure or damage and will adhere to all GlobalHealth privacy and security policies.

    TRAVEL:

    N/A

    SUPERVISORY RESPONSIBILITY:

    N/A

    OTHER DUTIES:

    This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

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