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Manager Optum Utilization Review Jobs in Riverside, CA

GQR Healthcare

Travel RN Case Manager

Irvine, CA · On-site

$2.1K - $2.2K/wk

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Irvine, California Start Date: August 3, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay ...

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All JobsOptum Utilization Review JobsManager Optum Utilization Review JobsManager Optum Utilization Review Jobs in Riverside, CA

Manager Optum Utilization Review information

See Riverside, CA salary details

$40.7K

$94.9K

$174.7K

How much do manager optum utilization review jobs pay per year?

As of Jul 19, 2026, the average yearly pay for manager optum utilization review in Riverside, CA is $94,949.00, according to ZipRecruiter salary data. Most workers in this role earn between $62,100.00 and $114,200.00 per year, depending on experience, location, and employer.

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 popular job titles related to Manager Optum Utilization Review jobs in Riverside, CA? For Manager Optum Utilization Review jobs in Riverside, CA, the most frequently searched job titles are:
What job categories do people searching Manager Optum Utilization Review jobs in Riverside, CA look for? The top searched job categories for Manager Optum Utilization Review jobs in Riverside, CA are:
What cities near Riverside, CA are hiring for Manager Optum Utilization Review jobs? Cities near Riverside, CA 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 Riverside, CA as of July 2026, with employment types broken down into 100% Full Time. Highlights an 50% In-person, and 50% Remote job distribution, with an average salary of $94,949 per year, or $45.6 per hour.

Concurrent Case Management RN

LSMA Management Inc

San Bernardino, CA • On-site

$85K - $100K/yr

Full-time

Posted 17 days ago

Job description

Description:

JOB SUMMARY:

The Concurrent Case Management RN is responsible for concurrent utilization review, care coordination, and discharge planning for inpatient members within a managed care environment. This role serves as a clinical resource to care management staff, supports compliance with regulatory and health plan requirements, and collaborates with providers, hospitals, and interdisciplinary teams to ensure medically necessary, cost-effective, and quality care.

The position performs medical necessity reviews using established criteria, monitors length of stay, facilitates transitions of care, and identifies opportunities to improve outcomes and reduce avoidable utilization.


Requirements:

MINIMUM & PREFERRED QUALIFICATIONS:

Education/Training

Minimum: High School diploma or equivalent required. Graduate of an accredited Registered Nursing program.

Preferred: Bachelor of Science in Nursing (BSN).


Experience

Minimum: Three (3) years of clinical nursing experience; 1-2 years in utilization management, case management, or managed care.

Preferred: Experience in a health plan, MSO, IPA, or acute setting with utilization review responsibilities.

Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.

Certification(s)

Current State Registered Nursing License.

Certified Case Manager (CCM) or Accredited Case Manager (ACM) preferred.

Skills, Knowledge & Abilities

· Knowledge of utilization management standards (CMS, DMHC, InterQual/Milliman)

· Strong clinical assessment and critical thinking skills

· Understanding of managed care and value-based care models

· Excellent written and verbal communication skills

· Ability to manage multiple cases and meet regulatory deadlines

· Proficiency with electronic medical records (EMR) and Microsoft Office applications

· Ability to work independently and collaboratively in a fast-paced environment

· Strong organizational and time management skills


PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS:

The physical, mental, and environmental demands described here are representative of those required to successfully perform the essential functions of this position, with or without reasonable accommodation. The role primarily involves sedentary work, including extended periods of sitting, computer use, and communication. The employee may occasionally be required to stand, walk, bend, and lift items up to 20 pounds. The position requires the ability to review detailed medical documentation, perform data entry, and maintain sustained concentration and attention to detail. The employee must be able to communicate effectively through verbal, written, and electronic means, including phone and video communication. Occasional travel to healthcare facilities or office locations may be required based on business needs.


PAY RANGE

$85,000 - $100,000 / annually

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