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Manager Optum Utilization Review Jobs in California

Prime Healthcare Management Inc

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Responsibilities Responsible for the quality and resource management of all authorizations and ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...

Corvel

Utilization Review Administrative Specialist

Folsom, CA · Remote

$16.74 - $26.92/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Utilization Review (UR) Intake Specialist provides staff support services including typing ... Strong interpersonal, time management and organizational skills * Ability to remain poised in ...

Prime Healthcare Management Inc

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Responsibilities Responsible for the quality and resource management of all authorizations and ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · Remote

$30.64 - $45.80/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Utilization Review Nurse gathers demographic and clinical information on prospective ... Strong time management skills with the ability to meet designated deadlines * Excellent written and ...

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · On-site

$30.64 - $45.80/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Utilization Review Nurse gathers demographic and clinical information on prospective ... Strong time management skills with the ability to meet designated deadlines * Excellent written and ...

Prime Healthcare

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Responsible for the quality and resource management of all authorizations and referrals with the ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...

CorVel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · On-site

$30.64 - $45.80/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Utilization Review Nurse gathers demographic and clinical information on prospective ... Strong time management skills with the ability to meet designated deadlines * Excellent written and ...

Prime Healthcare

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Responsibilities Responsible for the quality and resource management of all authorizations and ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...

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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 California?

The most popular types of Optum Utilization Review jobs in California are:

What are popular job titles related to Manager Optum Utilization Review jobs in California?

For Manager Optum Utilization Review jobs in California, the most frequently searched job titles are:

What job categories do people searching Manager Optum Utilization Review jobs in California look for?

The top searched job categories for Manager Optum Utilization Review jobs in California are:

What cities in California are hiring for Manager Optum Utilization Review jobs?

Cities in California with the most Manager Optum Utilization Review job openings:

Manager Optum Utilization Review jobs near you

Utilization Review Administrative Specialist

CorVel Healthcare Corporation

Folsom, CA • Remote

$16.74 - $26.92/hr

Full-time

Posted 10 days ago

Job description

The Utilization Review (UR) Intake Specialist provides staff support services including typing reports and correspondence, file handling and forms completion in addition to answering incoming telephone calls, supporting the goals of the Utilization Review / Case Management department, and of CorVel.

This is a remote position.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

  • Takes calls relating to precertification requests
  • Verifies that all patient, provider and facility information entered in system is accurate and up to date
  • Enters notes and service requests in CareMC system
  • Communicates with stakeholders in a timely and professional manner
  • Additional duties as assigned

KNOWLEDGE & SKILLS:

  • Ability to handle multiple priorities in a high-volume, fast-paced, team-oriented environment
  • Excellent written and verbal communication skills
  • Ability to meet designated deadlines
  • Computer proficiency and technical aptitude with the ability to utilize Microsoft Office including Excel spreadsheets
  • Strong interpersonal, time management and organizational skills
  • Ability to remain poised in stressful situations and communicate diplomatically via all methods of communication
  • Ability to work both independently and within a team environment

EDUCATION & EXPERIENCE:

  • High School diploma or equivalent required
  • A.A. degree or equivalent preferred

PAY RANGE

CorVel uses a market-based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $16.74 - $26.92 per hour

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

ABOUT CORVEL

CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

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