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Manager Optum Utilization Review Jobs in Oklahoma

PARKSIDE INC

Utilization Review Specialist

Tulsa, OK · On-site

The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to ... Maintains current knowledge of managed care requirements and accurately interprets these ...

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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 the most commonly searched types of Optum Utilization Review jobs in Oklahoma?

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

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

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

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

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

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

Cities in Oklahoma 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 Oklahoma as of August 2026, with employment types broken down into 83% Full Time, 15% Part Time, and 2% Contract. Highlights an 88% Physical, 2% Hybrid, and 10% Remote job distribution.

Utilization Review Specialist

Parkside Hospital

Tulsa, OK • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 28 days ago

Job description

Parkside provides professional purpose, hope, and healing. As a member of our staff, you will be part of a mission-driven team, dedicated to changing lives and changing communities, one patient at a time. 

Parkside Psychiatric Hospital & Outpatient Clinic is a comprehensive mental healthcare system providing acute inpatient care, residential treatment, and outpatient therapy. With a focus on society’s most vulnerable population, Parkside provides world-class mental health services for youth and adults. For over 65 years, Parkside’s physicians, therapists, and staff have provided state of the art, patient-centered care that propels families from hopeful to hope-filled. As a center of excellence, we cultivate talent and provide professional purpose. Together we facilitate healing, one patient at a time. 

We are looking for a Full Time Utilization Review Specialist! The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to limit possible recoupment from third party pay sources including Medicare, Medicaid, HMO or private insurance. Coordinates with clinicians, business office and medical records to achieve above goals.

Responsibilities:

• Prepares authorization paperwork, processes requests for authorizations, and reviews requests for accuracy.

• Communicates with clinicians regarding discharge issues relevant to patient’s pay source. Tracks due dates for authorization reviews and alerts clinicians.

• Communicates with clinicians regarding admissions and discharges to various units.

• Knowledgeable of criteria for Medicare, Medicaid, HMO and private insurance coverage. Maintains current knowledge of managed care requirements and accurately interprets these requirements to increase authorizations.

• Coordinates/completes the appeal process for authorization denials

• Performs audits of clinical services to ensure compliance with standards of third party pay sources and agency policies.

• Tracks unauthorized services and possible recoupment issues. Looks for possible corrections, trends.

 • Maintains a good working relationship within the department and with other departments.

• Documentation meets current standards and policies.

 • Maintains fit for duty. Acts in a professional manner and follows all Parkside policies and procedures.

• Orients new staff members to the unit

• Demonstrates the ability to be organized and flexible, acts appropriately in stressful/emergency situations. Able to provide Handle with Care when needed

• Performs other duties as assigned

  • Bachelor’s degree in related field from an accredited university required. Experience in lieu of Degree will be considered.
  • 2yrs minimal experience in health care, utilization review and business setting

Benefits include:

  • Medical, Dental, and Vision
  • Generous Paid Time Off and Holidays
  • 401K and match start immediately, and includes a generous match
  • Company Paid Life Insurance and Disability and more!

We are an Equal Opportunity Employer! 

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