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Manager Optum Utilization Review Jobs (NOW HIRING)

Discovery Institute NJ

Utilization Review

Marlboro, NJ · On-site

Monitor payer portals for authorization updates. * Assist with Medicaid and managed care authorization processes. * Participate in utilization review meetings and case conferences. * Generate reports ...

Discovery Institute

Utilization Review

Marlboro, NJ · On-site

Monitor payer portals for authorization updates. * Assist with Medicaid and managed care authorization processes. * Participate in utilization review meetings and case conferences. * Generate reports ...

Discovery Institute NJ

Utilization Review

Marlboro, NJ · On-site

Monitor payer portals for authorization updates. * Assist with Medicaid and managed care authorization processes. * Participate in utilization review meetings and case conferences. * Generate reports ...

Discovery Institute NJ

Utilization Review

Marlboro, NJ · On-site

Monitor payer portals for authorization updates. * Assist with Medicaid and managed care authorization processes. * Participate in utilization review meetings and case conferences. * Generate reports ...

Tampa General Hospital

Under the administrative supervision of the Director of Utilization Management, manages the daily activities of the Utilization Review Nurses and Case Management Extenders to ensure effective ...

New

Socket.dev

Manager, Utilization Review

Gainesville, FL · On-site

Overview The Manager of Utilization Review provides operational leadership and oversight for utilization review activities across the health system. This role is responsible for ensuring clinical ...

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How much do manager optum utilization review jobs pay per year?

As of Sep 12, 2026, the average yearly pay for manager optum utilization review in the United States is $91,011.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,500.00 and $109,500.00 per year, depending on experience, location, and employer.

What does a manager Optum Utilization Review do?

A Manager of Optum Utilization Review oversees a team responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They ensure that all reviews comply with regulatory standards, company policies, and clinical guidelines. Managers also collaborate with healthcare providers, monitor team performance, and help implement process improvements to optimize patient outcomes and resource use. Their role is vital in balancing quality patient care with cost-effective service delivery.

How does a manager Optum Utilization Review typically collaborate with clinical and non-clinical teams to ensure effective case management?

As a Manager in Optum Utilization Review, you will regularly coordinate with clinical teams such as nurses, physicians, and case managers to review patient cases for medical necessity and compliance with policies. You’ll also work closely with non-clinical staff, including data analysts and administrative professionals, to streamline workflows and support accurate documentation. Effective collaboration ensures timely decision-making, helps resolve escalated cases, and supports continuous quality improvement initiatives. This role often requires strong communication and leadership skills to align multidisciplinary teams and achieve organizational goals.

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

To thrive as a Manager, Optum Utilization Review, you need a background in healthcare management, clinical expertise (often as an RN or related field), and experience with utilization management processes. Familiarity with utilization review software, electronic health records (EHRs), and relevant certifications such as CCM (Certified Case Manager) or URAC accreditation is typically required. Strong leadership, analytical thinking, and effective communication skills help you guide teams and collaborate with providers and payers. These competencies are crucial for ensuring compliance, optimizing patient care, and achieving organizational goals in a complex healthcare environment.

What is the difference between Manager Optum Utilization Review vs Utilization Review Nurse?

AspectManager Optum Utilization ReviewUtilization Review Nurse
CredentialsTypically requires a nursing license, certifications in case management or utilization reviewRegistered Nurse (RN) license, certifications in case management or utilization review
Work EnvironmentSupervises teams, manages review processes, collaborates with healthcare providersConducts patient reviews, assesses medical necessity, documents findings
Employer & Industry UsageCommon in health insurance companies, managed care organizations, healthcare providersPrimarily in hospitals, insurance companies, healthcare organizations

The main difference is that the Manager Optum Utilization Review oversees the review process and team management, while the Utilization Review Nurse focuses on conducting individual patient assessments and reviews. Both roles require nursing credentials and knowledge of healthcare policies, but the manager has additional responsibilities in leadership and process oversight.

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Manager Optum Utilization Review jobs near you
Infographic showing various Manager Optum Utilization Review job openings in the United States as of September 2026, with employment types broken down into 86% Full Time, 13% Part Time, and 1% Contract. Highlights an 86% Physical, 2% Hybrid, and 12% Remote job distribution, with an average salary of $91,011 per year, or $43.8 per hour.

Utilization Review Manager

Mishawaka, IN • On-site

Neuropsychiatric Hospitals
See more jobs at Neuropsychiatric Hospitalsexternal

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 18 days ago

Job description

About Us
Specialized Care for the Patients Who Need It Most.
NeuroPsychiatric Hospitals (NPH) is dedicated to providing unparalleled service to our patients, team members, physicians, and families. We dare to do things differently, bringing together compassionate care, specialized expertise, and an interdisciplinary approach to meet the unique needs of those we serve. It is this commitment that distinguishes NPH as the healthcare provider of choice.
As a national leader in behavioral healthcare, NPH specializes in caring for patients with acute psychiatric and complex medical needs. Our hospitals provide patient-centered care through an interdisciplinary, multi-specialty approach, ensuring our patients receive the specialized support they need when they need it most.
With locations in Indiana, Michigan, Texas, Ohio, and Arizona, we are expanding access to our unique model of care across the United States. Join NPH and become part of a team that is daring to do things differently and making a lasting difference in the lives of our patients, families, and communities every day.
Overview
Doctors NeuroPsychiatric Hospital and Medical Behavioral Hospital of Mishawaka are seeking a Utilization Review Manager to oversee utilization review services and ensure compliance with CMS Conditions of Participation. This role leads efforts to promote effective utilization of healthcare resources, coordinate patient care across the continuum, support appropriate reimbursement, and reduce denials. The Utilization Review Manager will supervise staff supporting Doctors NeuroPsychiatric Hospital and Medical Behavioral Hospital of Mishawaka, with travel between both hospitals required to provide leadership, support, and case management.
Benefits of joining NPH
  • Competitive pay rates
  • Medical, Dental, and Vision Insurance
  • NPH 401(k) plan with up to 4% Company match
  • Employee Assistance Program (EAP) Programs
  • Generous PTO and Time Off Policy
  • Special tuition offers through Capella University
  • Work/life balance with great professional growth opportunities
  • Employee Discounts through LifeMart

Responsibilities
  • Lead and coordinate the hospital's Utilization Review and Case Management program across designated facilities.
  • Promote quality, cost-effective patient care through appropriate utilization of hospital resources, including review of medical necessity, level of care, length of stay, consultations, and discharge planning.
  • Oversee clinical reviews of patient records and documentation to ensure medical necessity, severity of illness, and continued stay are supported by InterQual, Milliman, hospital, CMS, and other applicable regulatory standards.
  • Coordinate initial and concurrent reviews with payors, including precertifications, continued stay certifications, length-of-stay updates, reconsiderations, appeals, peer-to-peer reviews, external reviews, and state fair hearings as needed.
  • Monitor patient cases throughout the entire episode of illness and identify barriers to care, discharge planning concerns, documentation gaps, and opportunities to improve outcomes and resource utilization.
  • Collaborate with physicians, nurses, social workers, medical records, finance, and other interdisciplinary team members to achieve appropriate patient outcomes within established length-of-stay guidelines.
  • Identify trends, problematic DRGs, diagnoses, procedures, and utilization patterns and develop strategies to improve quality, resource utilization, reimbursement, and denial management.
  • Partner with Medical Records, Finance, and physicians to promote accurate clinical documentation and coding and ensure appropriate reimbursement.
  • Oversee admission and discharge audits and ensure the completeness, accuracy, validity, and reliability of patient discharge information.
  • Ensure required provider certifications and documentation are completed and maintained in accordance with CMS and regulatory requirements.
  • Maintain accurate, timely, and real-time documentation in the electronic medical record and other applicable systems.
  • Supervise, support, and educate Utilization Review and Case Management staff, including communicating updates to policies, procedures, regulatory requirements, and payor guidelines.
  • Conduct interdisciplinary team meetings and facilitate communication among healthcare providers regarding utilization, case management, discharge planning, and patient care concerns.
  • Develop, implement, and evaluate quality improvement and utilization management initiatives designed to improve patient outcomes and efficiently manage healthcare resources.
  • Develop and monitor financial goals related to designated case types and utilize data and reporting to evaluate utilization, denials, reimbursement, and quality outcomes.
  • Prepare and compile utilization review, denial management, case management, and other required patient and hospital reports.
  • Maintain current knowledge of CMS Conditions of Participation, federal and state regulations, accreditation standards, payor requirements, and emerging trends and research related to utilization management and case management.
  • Serve as a resource and subject matter expert for utilization review, case management, resource utilization, and case mix reimbursement.
  • Participate in internal and external committees, meetings, councils, workgroups, and performance improvement activities as appropriate.
  • Maintain current knowledge of occurrence screening and risk management practices and support compliance with applicable policies and procedures.
  • Adhere to NPH's Corporate Compliance Policy, Code of Conduct, Conflict of Interest Policy, and all applicable hospital policies and procedures.
  • Perform other duties as assigned.

Qualifications
Education: Bachelor's degree in Nursing, Social Work, Behavioral Health, or Counseling field required. Master's degree preferred.
Experience:Minimum of 5 years of utilization review experience in a hospital setting is required. 5 years of case management experience, including discharge planning in a hospital setting preferred. Minimum of 3 years' experience as a supervisor and/or manager in utilization review role is required.
Licensure: RN, LPN, Social work or Counselor State Licensure is preferred. Case Management certification preferred.
Skills: Strong organizational, prioritization, problem-solving, and time-management skills. Ability to work independently and collaboratively with interdisciplinary teams. Knowledge of Utilization Management, Case Management, care management plans, and critical pathways. Knowledge of CMS, regulatory, accreditation, and confidentiality requirements related to healthcare and utilization management. Strong clinical data analysis, research, and documentation skills. Excellent verbal and written communication skills with physicians, healthcare providers, patients, families, and other stakeholders. Proficiency with Microsoft Office, email, electronic health records, and computer systems.
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