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Manager Optum Utilization Review Jobs in Oregon (NOW HIRING)

St. Tammany Parish Hospital

$85 - $110/hr

The Utilization Manager is responsible to assist in the development, planning, coordination, and ... Job responsibilities include but are not limited to the following: daily review of medical records ...

New

Asante

Case Management Specialist

Medford, OR · On-site

$23.28 - $32.02/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

They utilize communication, organizational, and problem-solving skills to carry out the post-hospital care plans and interventions, utilization review, and denials management activities as defined by ...

GQR Healthcare

Travel RN Case Manager

Prairie City, OR · On-site

$2.7K - $2.8K/wk

  • Medical

  • Dental

  • Vision

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Prairie City, Oregon Start Date: August 19, 2026 Profession: Registered Nurse (RN) Facility: Skilled ...

Centene

Remote Medical Director, Appeals

OR · On-site +1

$236K - $449K/yr

  • Medical

  • Retirement

  • PTO

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

Centene

Remote Medical Director, Inpatient Medicare

OR · On-site +1

$236K - $449K/yr

  • Medical

  • Retirement

  • PTO

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

Centene

Clinical Appeals Coordinator

OR · On-site +1

$33.71 - $60.67/hr

  • Medical

  • Retirement

  • PTO

Managed care or utilization review experience preferred. License/Certification: LPN, LVN, or RN license. Specialty Therapy Requirement: Master's degree in area of specialty therapy or equivalent ...

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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 Oregon?

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

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

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

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

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

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

Cities in Oregon 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 Oregon as of June 2026, with employment types broken down into 77% Full Time, 11% Part Time, 11% Contract, and 1% Nights. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution.

RN Utilization Manager (PRN)

St. Tammany Parish Hospital

On-site

$85 - $110/hr

Other

Posted yesterday

New

Job description

JOB DESCRIPTION AND POSITION REQUIREMENTS

Scheduled Weekly Hours: TBD


Work Shift: (Usually 6 P.M. - 11 P.M.)


Summary of the Job: The Utilization Manager is responsible to assist in the development, planning, coordination, and administration of the activities of Utilization Management. Job responsibilities include but are not limited to the following: daily review of medical records to determine appropriateness and medical necessity of admission, continued stay, use of resources, and discharge readiness. Assumes responsibilities delegated by the Department Head.


Minimum Qualifications: Graduate of accredited school of Nursing and maintains current R.N. licensure by the Louisiana State Board of Nursing. Five years of hospital nursing experience preferred. Experience in the field of Utilization Management activities highly preferred. Basic understanding of CPT-ICD-9 coding principles and DRG management preferred. Graduate of accredited school of Nursing and maintains current R.N. licensure by the Louisiana State Board of Nursing. Ability to demonstrate effective written and verbal communication skills and possess emotional and professional maturity. Highly organized and efficient in establishing priorities and performing tasks within specific timeframes. Self-motivator requiring minimal supervision. Views problems as a challenge and investigates alternatives which demand creativity, flexibility and the ability to work under stress. Responsible for maintaining strict confidentiality of all verbal & written information and documents. Knowledgeable in the Utilization Management review process.


Physical Demands: Must possess good physical health. Some requirements include but are not limited to standing, sitting or walking for long periods of time. Lifting at least 10 pounds is required. Physical Effort required: Constant (67%-100%) – seeing Frequently (34%-66%) - handling/feeling, talking, hearing Occasionally (1%-33%) – lifting, carrying, pushing/pulling, stooping, crouching, reaching


Contact Information: Jennifer Saint, HR Talent Partner Talent Acquisition - Human Resources EMPLOYMENT


Each St. Tammany Health System staff member is expected to conduct himself or herself according to our mission, vision and values. Please take time to review those expectations, which can be found by clicking here, before applying for employment. If you feel you are unable to demonstrate those characteristics, we respectfully request that you do not proceed with the application process.


EQUAL OPPORTUNITY EMPLOYER St. Tammany Health System is an Equal Opportunity Employer. St. Tammany Health System is committed to equal employment opportunity for all employees and applicants without regard to race, color, religion, sex, age, national origin or ancestry, citizenship, sexual orientation, gender identity, veteran status, disability status, genetic information or any other protected characteristic under applicable law.


St. Tammany Health System is a full-service acute care facility that delivers today’s life-improving procedures with the latest technology, highest quality and the utmost care to area residents. From wellness and prevention to diagnosis, treatment, rehabilitation and recovery, the St. Tammany Health System delivers the very latest technology, the most accomplished specialists and highly personalized, caring staff to ensure patients and their families receive world-class healthcare close to home.


St. Tammany Health System is an independent service district in a clinically integrated partnership with Ochsner Health System. Together, the two organizations focus on aligning their healthcare offerings to best serve patients and families in west St. Tammany Parish and surrounding areas.

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