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Director Utilization Management Jobs in Oklahoma

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Director Utilization Management information

What is a director utilization management?

A Director of Utilization Management oversees the review and approval of medical services to ensure they are necessary, efficient, and cost-effective. They develop strategies to improve care quality while managing healthcare costs, working closely with providers, payers, and regulatory bodies. Their responsibilities include policy development, compliance with healthcare regulations, and leading a team of utilization review professionals. This role is common in hospitals, insurance companies, and managed care organizations.

What are the typical daily responsibilities of a director utilization management?

A Director Utilization Management generally oversees a team responsible for reviewing patient care to ensure appropriate resource use and compliance with payer requirements. Daily tasks may include analyzing utilization data, developing policy and process improvements, collaborating with clinical and administrative staff, and addressing escalated cases or issues. Directors frequently attend strategy meetings, conduct staff training, and engage with external partners like insurance providers. This role requires balancing administrative oversight with hands-on problem solving to support both cost efficiency and quality patient care.

What are the key skills and qualifications needed to thrive in the director utilization management position, and why are they important?

To thrive as a Director Utilization Management, you need a strong background in healthcare administration, case management, and data-driven decision-making, often supported by a clinical degree and several years of management experience. Familiarity with utilization management software, electronic health records (EHRs), and certifications such as CCM or ACM are typically valued. Exceptional leadership, communication, and problem-solving skills distinguish top performers in this role. These competencies are vital for optimizing resource use, ensuring regulatory compliance, and leading teams to meet quality care standards.

What does a director of utilization management do?

A director of utilization management oversees the review and approval of healthcare services to ensure they are medically necessary and cost-effective. They develop policies, manage teams of reviewers, and collaborate with healthcare providers and insurance companies to optimize patient care and resource utilization.

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

The most popular types of Utilization Management jobs in Oklahoma are:

What are popular job titles related to Director Utilization Management jobs in Oklahoma?

For Director Utilization Management jobs in Oklahoma, the most frequently searched job titles are:

What job categories do people searching Director Utilization Management jobs in Oklahoma look for?

The top searched job categories for Director Utilization Management jobs in Oklahoma are:

What cities in Oklahoma are hiring for Director Utilization Management jobs?

Cities in Oklahoma with the most Director Utilization Management job openings:

Director Utilization Management jobs near you
Infographic showing various Director Utilization Management job openings in Oklahoma as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 15% Part Time, and 3% Contract. Highlights an 86% Physical, 2% Hybrid, and 12% Remote job distribution.

Medical Management - Utilization Management RN

CommunityCare

Tulsa, OK • On-site

Other

Re-posted 9 hours ago

Job description

JOB SUMMARY:
Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high risk members, and other members identified with at risk or high utilization needs. Functions as an active team member of the Utilization Management Team.
KEY RESPONSIBILITIES:
  • Performs utilization review of outpatient and ancillary services as well as inpatient and post-acute services when indicated.
  • Determines medical necessity and appropriateness of services using clinical review criteria.
  • Accurately documents all review determinations and contacts providers and members according to established timeframes.
  • Appropriately identifies and refers cases that do not meet established clinical criteria to the Medical Director.
  • Appropriately identifies and refers quality issues to Medical Management leadership.
  • Appropriately identifies potential cases for Care Management programs.
  • Collaborates with physicians and other providers to facilitate provision of services throughout the health care continuum.
  • Performs accurate data entry.
  • Communicates appropriate information to other staff members as necessary/required.
  • Participates in continuing education initiatives.
  • Collaborates with other departments as needed.
  • Performs other duties as assigned.
QUALIFICATIONS:
  • Knowledge of managed care and associated group benefit plans.
  • Possess strong oral and written communication skills.
  • Ability to reason logically and to use good judgment when interpreting materials or situations.
  • Knowledge of community- based resources.
  • Must have excellent organizational skills and be able to perform multiple tasks.
  • Proficient in Microsoft applications.
  • Excellent time management and documentation skills.
  • Successful completion of Health Care Sanctions background check.
EDUCATION/EXPERIENCE:
  • Graduation from accredited School of Nursing.
  • Current, active, unrestrictive license to practice as a Registered Nurse in the State of Oklahoma.
  • Three years of acute care experience preferred.
  • Two years of experience working with population health preferred.
  • Previous discharge planning or case management experience preferred.
  • Managed care experience a plus.

CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

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