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Manager Optum Utilization Review Jobs (NOW HIRING)

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL · On-site

$55K - $70K/yr

Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No ... cycle management professionals specializing in the substance use disorder, mental health, and ...

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL · On-site

$55K - $70K/yr

Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No ... cycle management professionals specializing in the substance use disorder, mental health, and ...

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Manager Optum Utilization Review information

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$91K

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

As of Jul 11, 2026, the average yearly pay for manager optum utilization review in the United States is $91,011.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,500.00 and $109,500.00 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.

More about Manager Optum Utilization Review jobs
What cities are hiring for Manager Optum Utilization Review jobs? Cities with the most Manager Optum Utilization Review job openings:
What are the most commonly searched types of Optum Utilization Review jobs? The most popular types of Optum Utilization Review jobs are:
What states have the most Manager Optum Utilization Review jobs? States with the most job openings for Manager Optum Utilization Review jobs include:
What job categories do people searching Manager Optum Utilization Review jobs look for? The top searched job categories for Manager Optum Utilization Review jobs are:
Manager Optum Utilization Review jobs near you
Infographic showing various Manager Optum Utilization Review job openings in the United States as of July 2026, with employment types broken down into 85% Full Time, 13% Part Time, 1% Temporary, and 1% Contract. Highlights an 86% Physical, 1% Hybrid, and 13% Remote job distribution, with an average salary of $91,011 per year, or $43.8 per hour.
Utilization Review Manager

Utilization Review Manager

Harbor Oaks Hospital

New Baltimore, MI • On-site

$25 - $35/hr

Full-time

Posted 22 days ago

Job description

Overview

Harbor Oaks Hospital is looking for a Utilization Review Manager to join our team!

Harbor Oaks Hospital, New Baltimore's leading Mental Health and Addiction Treatment Center is seeking a passionate Utilization Review Manager to work at our facility in New Baltimore, MI. 

Non-Exempt Position

Full Time Position

Monday - Friday - Day Shift 

Rate of Pay: $25.00 - $35.00 per hour (based on experience)

Responsibilities

PURPOSE STATEMENT:

Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patient's provider benefits for their needs. 

ESSENTIAL FUNCTIONS:

  • Provide consultation and guidance regarding admissions and patient length of stay to a variety of payers.
  • Secure authorizations with insurance companies for inpatient treatment and continue to obtain authorizations for duration of patient stay.
  • Evaluate the utilization program for compliance with regulations, policies and procedures.
  • Review clinical documentation from denied stays against criteria to determine if documentation is adequate for requested treatment.
  • Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation.

OTHER FUNCTIONS:

  • Perform other functions and tasks as assigned.
Qualifications

LICENSES/DESIGNATIONS/CERTIFICATIONS:

  • If applicable, current licensure as an LPN or RN or LPC, or LMSW or LLMSW within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
  • CPR and de-escalation and restraint certification required (training available upon hire and offered by facility).
  • First aid may be required based on state or facility requirements.

HOAK01

#LI-HOH

Employment Type: FULL_TIME

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