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Manager Optum Utilization Review Jobs in Hawaii (NOW HIRING)

Kaiser Permanente

Utilization Review Nurse I

Wailuku, HI · On-site

Supports high-quality consultation by: communicating with physicians, managers, staff, members, and ... Performs utilization reviews by: following standard policies and procedures when conducting reviews ...

AlohaCare

Medical Director

Honolulu, HI · On-site

Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. * Performs medical review activities pertaining to utilization review ...

AlohaCare

Medical Director

Honolulu, HI

Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. * Performs medical review activities pertaining to utilization review ...

AlohaCare

Medical Director

Honolulu, HI · On-site

$151.54 - $185.98/hr

Provides medical leadership of all utilization management, cost containment, and medical quality improvement activities. * Performs medical review activities pertaining to utilization review, quality ...

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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 popular job titles related to Manager Optum Utilization Review jobs in Hawaii?

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

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

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

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

Cities in Hawaii 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 Hawaii as of August 2026, with employment types broken down into 2% As Needed, 86% Full Time, 7% Part Time, 2% Temporary, and 3% Contract. Highlights an 89% In-person, 2% Hybrid, and 9% Remote job distribution.

Utilization Review Nurse I

Kaiser Permanente

Wailuku, HI • On-site

Other

This job post has expired today. Applications are no longer accepted.

Job description

Job Summary:
In addition to the responsibilities listed below, this position is also responsible for leveraging clinical knowledge of evidence-based guidelines, insurance policies, and clinical criteria to consult on the medical necessity, level of care, and duration of treatment required for basic reviews, and collaborating with the health care team, members, and caregivers to assist in discharge planning, cost of care options, and/or coordinating referrals to appropriate services based on medical necessity.
Essential Responsibilities:
  • Pursues effective relationships with others by sharing information with coworkers and members. Listens to and addresses performance feedback. Pursues self-development; acknowledges strengths and weaknesses, and takes action. Adapts to and learns from change, challenges, and feedback. Responds to the needs of others to support a business outcome.
  • Completes routine work assignments by following procedures and policies and using data, and resources with oversight and management. Collaborates with others to address business problems; escalates issues or risks as appropriate; communicates progress and information. Adheres to established priorities, deadlines, and expectations. Identifies and speaks up for improvement opportunities.
  • Supports high-quality consultation by: communicating with physicians, managers, staff, members, and/or caregivers regarding requirements related to medical necessity and benefit denials across the continuum of care, under direct supervision; and leveraging working knowledge to ensure the correct and consistent application, interpretation, and utilization of member health care benefits, cost of care options, and coverage by members and physicians.
  • Supports education and compliance initiatives by: remaining up-to-date and discussing with the team the relevant state and federal regulations, guidelines, criteria, and documentation requirements that affect utilization management; and participating in education and training programs for staff and physicians at the local level to promote best practices in utilization management.
  • Assists in quality improvement efforts by: observing and escalating utilization patterns, trends, and opportunities for improvement; learning about utilization review workflows/processes including corrective action plans and standard work, and identifying deficiencies in workflows; and learning and actively adhering to utilization policies, procedures, and guidelines to ensure compliant and cost-effective care.
  • Performs utilization reviews by: following standard policies and procedures when conducting reviews of medical records and treatment plans to evaluate the medical necessity, appropriateness, and efficiency of requested health care services, under direct supervision; and beginning to assess the ongoing need for services, identifying potential issues/delays, and recommending appropriate actions for standard member cases.

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