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Manager Optum Utilization Review Jobs in Arizona

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...

UHS

Utilization Review Manager

Phoenix, AZ

Responsibilities Utilization Review Manager (URM) Position: Full-Time Shift: Daytime This position includes a $1,500 sign on bonus! For over 60 years, Calvary Healing Center has provided a full ...

UHS

Utilization Review Manager

Phoenix, AZ · On-site

Responsibilities Utilization Review Manager (URM) Position: Full-Time Shift: Daytime This position includes a $1,500 sign on bonus! For over 60 years, Calvary Healing Center has provided a full ...

UHS

Utilization Review Manager

Phoenix, AZ

Responsibilities Utilization Review Manager (URM) Position: Full-Time Shift: Daytime This position includes a $1,500 sign on bonus! For over 60 years, Calvary Healing Center has provided a full ...

UHS

Utilization Review Manager

Phoenix, AZ · On-site

Responsibilities Utilization Review Manager (URM) Position: Full-Time Shift: Daytime This position includes a $1,500 sign on bonus! For over 60 years, Calvary Healing Center has provided a full ...

Mission Hospital

RN - Utilization Review

Tuba City, AZ · On-site

$2.5K/wk

Utilization Review and Clinical Evaluation : * Review patient medical records, treatment plans, and ... Collaborate with physicians, case managers, and other healthcare professionals to ensure that ...

New

ICONMA

Utilization Review RN

Tuba City, AZ · On-site

Utilization Review RN Our client, a Healthcare company, is looking for a Utilization Review RN for ... manage resource use to control costs, communicate with payers to prevent denials, and ensure ...

GlobalPoint

Travel Utilization Review RN

Tuba City, AZ · On-site

GlobalPoint is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Tuba City, Arizona. & Requirements * Specialty: Utilization Review * Discipline: RN * Start Date ...

Zack Group

Travel Utilization Review RN

Tuba City, AZ · On-site

Zack Group is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Tuba City, Arizona. & Requirements * Specialty: Utilization Review * Discipline: RN * Start Date ...

Care Career

Travel Utilization Review RN

Tuba City, AZ · On-site

Care Career is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Tuba City, Arizona. & Requirements * Specialty: Utilization Review * Discipline: RN * Start Date ...

Medlivo

Travel Utilization Review RN

Tuba City, AZ · On-site

Medlivo is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Tuba City, Arizona. & Requirements * Specialty: Utilization Review * Discipline: RN * Duration: 13 ...

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Manager Optum Utilization Review information

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.

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.

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 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.

What are the most commonly searched types of Optum Utilization Review jobs in Arizona? The most popular types of Optum Utilization Review jobs in Arizona are:
What are popular job titles related to Manager Optum Utilization Review jobs in Arizona? For Manager Optum Utilization Review jobs in Arizona, the most frequently searched job titles are:
What job categories do people searching Manager Optum Utilization Review jobs in Arizona look for? The top searched job categories for Manager Optum Utilization Review jobs in Arizona are:
What cities in Arizona are hiring for Manager Optum Utilization Review jobs? Cities in Arizona with the most Manager Optum Utilization Review job openings:
Manager Optum Utilization Review jobs near you
Infographic showing various Manager Optum Utilization Review job openings in Arizona as of July 2026, with employment types broken down into 86% Full Time, 12% Part Time, 1% Temporary, and 1% Contract. Highlights an 86% Physical, 1% Hybrid, and 13% Remote job distribution.

Utilization Review Nurse

Oscar Health

Tempe, AZ • Remote

$35 - $45.94/hr

Full-time

Re-posted 25 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

251st of 303 rated insurance

Job description

Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team.

About the role:

You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

You will report into the Supervisor, Utilization Review.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Pay Transparency: The base pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

  • Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines
  • Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines
  • Meet required decision-making SLAs
  • Refer members for further care engagement when needed
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
  • Associate Degree - Nursing or Graduate of Accredited School of Nursing Or Successful completion of Nursing Diploma Program in Accredited School of Nursing
  • Ability to obtain additional state licenses to meet business needs
  • 1+ year of utilization review experience in a managed care setting
  • Strong experience utilizating MCG (Milliman Care Gudielines)
  • 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)
  • Weekend availability is required; all applicants must be able to work at least one weekend day (Saturday or Sunday) each week.

Bonus points:

  • BSN
  • Previous experience conducting concurrent or inpatient reviews for a managed care plan

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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