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Manager Optum Utilization Review Jobs in Hawaii (NOW HIRING)

Spectrum Healthcare Resources

UMRN-Hybrid

Honolulu, HI · On-site

Completion of an accredited Certified Professional Utilization Review (CPUR) program * Certified Case Manager (CCM) issued by the Commission for Case Manager Certification. * Must have access to ...

Spectrum Healthcare Resources

UMRN-Hybrid

Honolulu, HI · Hybrid

Completion of an accredited Certified Professional Utilization Review (CPUR) program * Certified Case Manager (CCM) issued by the Commission for Case Manager Certification. * Must have access to ...

Spectrum Healthcare Resources

UMRN-Hybrid

Honolulu, HI · Hybrid

Completion of an accredited Certified Professional Utilization Review (CPUR) program * Certified Case Manager (CCM) issued by the Commission for Case Manager Certification. * Must have access to ...

Aldridge Pite LLP

Title Reviewer

Honolulu, HI · On-site

Aldridge Pite, LLP is a multi-state law firm that focuses heavily on the utilization of technology ... Update internal Case Management System * Assist with other duties and special projects as needed ...

UnitedHealth Group

Specialty Pharmacist

Honolulu, HI · On-site

$91K - $163K/yr

Review and manage specialty medication therapies for complex, chronic, or high-cost conditions ... Oversee prior authorizations and utilization management, ensuring compliance with payer and program ...

UnitedHealth Group

Specialty Pharmacist

Honolulu, HI

$91K - $163K/yr

Review and manage specialty medication therapies for complex, chronic, or high-cost conditions ... Oversee prior authorizations and utilization management, ensuring compliance with payer and program ...

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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.

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.

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, 84% Full Time, 10% Part Time, 2% Temporary, and 2% Contract. Highlights an 89% In-person, 2% Hybrid, and 9% Remote job distribution.

Clinical Care Coordinator

REHAB Hospital of the Pacific

Honolulu, HI • On-site

$83K - $124K/yr

Full-time

Re-posted 5 days ago

Key responsibilities

  • Coordinate and facilitate transitions of care for patients, including discharge planning and interdisciplinary communication.

  • Monitor and review patient progress, collaborate with providers and payers for authorizations, and ensure compliance with regulations and standards.

  • Support patient advocacy, education, and ensure regulatory compliance through documentation and adherence to policies.

Job description

Position Title: Clinical Care Coordinator
FLSA Status: Exempt
Department: Care Coordination
Reports To: Care Coordination Manager
POSITION SUMMARY:
The Clinical Care Coordinator is responsible for coordinating and facilitating the continuum of care for patients admitted to the Rehabilitation Hospital of the Pacific. The role integrates utilization management, discharge planning, interdisciplinary collaboration, payer communication, patient advocacy, regulatory compliance, and transition-of-care coordination to promote safe, timely, and appropriate patient progression throughout the rehabilitation stay.
The Clinical Care Coordinator functions as a central member of the interdisciplinary rehabilitation team and serves as a liaison between patients, families, physicians, nursing, therapy disciplines, payers, community resources, and post-acute providers. The position supports patient-centered care while ensuring compliance with CMS regulations, IRF standards, payer requirements, and organizational policies.
Wage Range: $83,208.31 to $124,812.48/year. The actual wage is dependent on the applicant's relevant experience and qualifications for this position. The wage range for this position may be subject to change in the future depending on a variety of factors such as market conditions, business needs, legal developments, and other appropriate factors.
REQUIRED QUALIFICATIONS:
Certification/Licensure: STANDARD FOR PATIENT CARE POSITIONS:
  • One of the following, depending on discipline:
    • Registered Nurse (RN)
    • Licensed Clinical Social Worker (LCSW)
    • Licensed Social Worker (LSW)
  • Current BLS certification
  • Completion of competencies and other job-related and REHAB requirements. (move to essential job functions)

Education:
  • Bachelor's degree in Nursing, Social Work, Case Management, Healthcare Administration, or related healthcare field required.

Skills/Experience:
  • Ability to safely and effectively manage patients' mobility.

PREFERRED QUALIFICATIONS:
Certification/Licensure:
  • Certified Case Manager (CCM)
  • Accredited Case Manager (ACM)

Education:
  • Bachelor's degree in Nursing or Master's degree in Nursing or Social Work

Skills/Experience:
  • Minimum of 1 year of acute care, rehabilitation, case management, or care coordination experience.
  • Experience with utilization review, discharge planning, and payer communication.
  • Knowledge of rehabilitation diagnoses and functional outcomes and post-acute levels of care.

CORE VALUES
Models REHAB's core values, HEART, in daily actions. Honesty - Speak and act with truth and respect. Engagement - Embrace and commit to our mission, vision and values. Aloha - Serve others with a spirit of kindness and compassion. Resilience - Rebound and recover with a sense of urgency. Teamwork - Work together for success.
ESSENTIAL FUNCTIONS:
  • Comprehensive care coordination by assessing the potential barriers to discharge, facilitating interdisciplinary communication, coordinating transitions across the continuum of care, advocacy, and assistance with complex discharge planning to ensure safe and timely patient transition.
  • Utilization review and medical necessity by monitoring progress and therapy participation while collaborating with providers and payers for authorizations, appropriate continued stays, and ensuring compliance with CMS regulations, payer requirements, and IRF standards.
  • Discharge planning and transition of care
  • Interdisciplinary team collaboration
  • Patient advocacy and education
  • Regulatory compliance and documentation by ensuring compliance with CMS regulations, IRF criteria, payer requirements, hospital policies, HIPAA, accreditation stands, and patient rights. Support quality improvement initiatives, regulatory readiness, and organization goals related to length of stay, readmission prevention, and care transition.
  • Quality improvement and operation responsibilities
  • High-risk and complex case management
  • Uses sound judgment and ensures patient safety.
  • Follows and adheres to all organizational and departmental policies and guidelines, code of conduct, and REHAB employee handbook.
  • Performs other duties as assigned.

PROFESSIONALISM AND COMPLIANCE COMPETENCIES
Maintain a high level of proficiency in the following REHAB competencies.
Job Knowledge
Accountability
Communication and interpersonal/relationship building skills
Adaptability and problem solving, decision making
Organization and project management
EQUIPMENT, TOOLS, WORK AIDS USED
Office equipment, including telephone, computer and multifunction devices (MFDs). Google's G Suite, report writer and database software.

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