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Manager Optum Utilization Review Jobs in Florida

Banyan

Utilization Review Specialist

Pompano Beach, FL · On-site

$50K - $65K/yr

Utilization Review Specialist | Remote | Full-Time $50,000 - $65,000 Annually | Weekdays (Weekend ... In this remote role, you'll manage a caseload of 50-75 patients, conducting admission and ...

Oscar Health

Utilization Review Nurse

Miami, FL · 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 ...

Miami Jewish Health

Utilization Review Nurse

Miami, FL · On-site

All utilization management activities are performed in accordance with CMS PACE regulations (42 CFR ... Concurrent Review & Care Progression * Conducts timely concurrent reviews with hospitals and ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Oakland Park, FL

The Director of Utilization Management is also responsible for ensuring that the utilization review process meets the integrity standards set by FLBHC and UHS. The Director: interfaces with clinical ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Oakland Park, FL · On-site

The Director of Utilization Management is also responsible for ensuring that the utilization review process meets the integrity standards set by FLBHC and UHS. The Director: interfaces with clinical ...

SECUR

Utilization Review Nurse

Tampa, FL · On-site

$73K - $110K/yr

The Utilization Review Nurse performs care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote ...

SBT

Be Seen First

Utilization Review (UR) Specialist

Boca Raton, FL · On-site

$60K - $70K/yr

Utilization Review (UR) Specialist Location: Boca Raton, FL Job Type: Full-time, In-Person Pay: $60 ... Manage a caseload of approximately 30-50 patients * Maintain professional verbal and written ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Jacksonville, FL · On-site

Responsibilities The Utilization Review Director is responsible for directing and overseeing the Utilization Management Department. This includes the implementation of case management scenarios ...

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Manager Optum Utilization Review information

What does a Manager of 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 in 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 Florida? The most popular types of Optum Utilization Review jobs in Florida are:
What are popular job titles related to Manager Optum Utilization Review jobs in Florida? For Manager Optum Utilization Review jobs in Florida, the most frequently searched job titles are:
What job categories do people searching Manager Optum Utilization Review jobs in Florida look for? The top searched job categories for Manager Optum Utilization Review jobs in Florida are:
What cities in Florida are hiring for Manager Optum Utilization Review jobs? Cities in Florida 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 Florida as of July 2026, with employment types broken down into 85% Full Time, 14% Part Time, and 1% Contract. Highlights an 93% Physical, 3% Hybrid, and 4% Remote job distribution.

Manager, Utilization Review

Health Business Solutions LLC

Cooper City, FL • Remote

Full-time

Posted 26 days ago

Job description

The Manager, Utilization Review is responsible for overseeing the daily operations of the Utilization Review for one of our clients and leading a team of Utilization Review Nurses. This role involves ensuring efficient care coordination, managing healthcare costs, and maintaining high-quality patient care standards. The Manager, Utilization Review will collaborate with various healthcare professionals to improve patient outcomes and streamline care processes.

Key Responsibilities:

1. Leadership and Team Management:

• Supervise and mentor a team of Utilization Review Nurses, providing guidance and support to ensure excellent performance.

• Foster a collaborative and cohesive work environment within the department.

• Conduct regular staff meetings, performance evaluations, and staff development activities.

2. Care Coordination and Oversight:

• Oversee the development and implementation of individualized care plans for patients.

• Collaborate with the healthcare team to ensure coordinated and efficient patient care across different healthcare settings.

• Monitor and assess the appropriateness of care plans and resource utilization.

3. Quality Improvement:

• Implement and monitor quality improvement initiatives to enhance patient outcomes and compliance with healthcare regulations.

• Analyze data and metrics to identify areas for improvement in care coordination processes.

4. Budget Management:

• Manage the department's budget and resource allocation efficiently while maintaining high-quality patient care.

• Collaborate with finance and administrative teams to optimize resource utilization.

5. Staff Development:

• Provide ongoing training and education to Utilization Review Nurses to keep them updated on best practices and regulatory changes.

• Encourage professional growth and development within the department.

6. Patient Advocacy:

• Serve as a patient advocate, ensuring that patients' needs and preferences are addressed throughout their healthcare journey.

• Participate in complex case reviews and offer guidance on challenging patient cases.

7. Documentation and Compliance:

• Ensure accurate and timely documentation of patient records, care plans, and progress notes in accordance with regulatory standards.

Qualifications:

• Current RN (Registered Nurse) license. Compact or Multi-State License strongly preferred.

• Bachelor's degree in Nursing (BSN) required Masters (MSN) preferred.

• Previous experience in case management or care coordination, with at least 2 years in a leadership role.

• Strong clinical assessment and critical thinking skills.

• Excellent communication and interpersonal skills.

• Knowledge of healthcare regulations, insurance processes, and quality improvement methodologies.

• Proficiency in electronic health records (EHR) and healthcare software.

• Dedication to patient-centered care and a commitment to ethical practice.

If you are an experienced and visionary nurse leader who is passionate about improving patient care and outcomes, we invite you to apply for the Utilization Review Nurse Manager position. Join our team and lead the way in optimizing patient care. Apply today!


Health Business Solutions (HBiz) is an Equal Opportunity Employer. We are committed to providing equal employment opportunities to all employees and applicants without regard to race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, disability, genetic information, veteran status, or any other status protected by applicable federal, state, or local law.

HBiz complies with all applicable employment laws for remote and multi-state hiring and provides reasonable accommodations as required by law.


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