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Manager Optum Utilization Review Jobs (NOW HIRING)

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...

Village Care

Utilization Review Nurse

Manhattan, NY · Remote

$95K - $105K/yr

... LOCAL MANAGED CARE COMPANY - VILLAGE CARE! VillageCare is looking for a self-motivated and ... Utilization Review Nurse for a Full-Time position. This is an exciting and dynamic position from ...

Shannon Health

Utilization Review Nurse

Big Spring, TX · On-site

Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...

UHS

Utilization Review Manager

Grand Rapids, MI

As a part of our continued success and growth, we are seeking qualified applicants for a Utilization Review Manager. Position Description: The Utilization Manager is responsible for directing and ...

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 ...

Village Care

Utilization Review Nurse

Manhattan, NY · On-site

$95K - $105K/yr

... LOCAL MANAGED CARE COMPANY - VILLAGE CARE! VillageCare is looking for a self-motivated and ... Utilization Review Nurse for a Full-Time position. This is an exciting and dynamic position from ...

Southeast Health

Utilization Review Nurse

Dothan, AL · On-site

The Utilization Review case manager collaborates with all components of the healthcare system, managing appropriate use of acute care to aid in the achievement of quality outcomes, fiscal ...

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

As of May 31, 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 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 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 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 May 2026, with employment types broken down into 5% Internship, 14% As Needed, 10% Full Time, 24% Part Time, 42% Contract, and 5% Nights. Highlights an 100% Physical job distribution, with an average salary of $91,011 per year, or $43.8 per hour.
Utilization Review Coordinator

Utilization Review Coordinator

Oceans Healthcare

Norman, OK • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 18 days ago

Oceans Healthcare rating

4.7

Company rating: 4.7 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

Job description

Description
Full-time Utilization Review Coordinator
  • Associate's Degree with emphasis on healthcare or Bachelor's degree in social services field preferred.
  • At least one year psychiatric/chemical dependency experience with good working psychiatric/medical knowledge.
  • Utilization review experience REQUIRED

The Utilization Review Coordinator is responsible for management of all utilization review activities for the facility's inpatient, partial hospitalization, and outpatient programs. Conducts concurrent reviews of all medical records to ensure criteria for admission and continued stay are met and documented, and to ensure timely discharge planning. Coordinates information between third party payers and medical/clinical staff members. Interacts with members of the medical/clinical team to provide a flow of communication and a medical record which documents and supports level and intensity of service rendered. All duties to be done in accordance with Joint Commission, Federal and State regulations, Oceans' Mission, policies and procedures and Performance Improvement Standards.
Benefits We Offer:
Medical, Dental, Vision Coverage (Multiple Plan Options) - Eligible first of the month after 30 days.
401 (k) Retirement Savings Plan with Discretionary Company Match
Tuition Reimbursement
Daily Pay
Paid Time Off
Competitive Market Compensation
Short Term Disability, Long Term Disability
Life Insurance
Employee Assistance Program
Essential Functions:
  1. Identifies and reports appropriate use, under-use, over-use and inefficient use of services and resources to ensure high quality patient care is provided in the least restrictive environment and in a cost-effective manner.
  2. Conducts review of all inpatient, partial hospitalization, and outpatient records as outlined in the Utilization Review/Case Management plan to (1) determine appropriateness and clinical necessity of admissions, continued stay, and or rehabilitation, and discharge; (2) determine timeliness of assessments and evaluations; i.e. H&Ps, psychiatric evaluation, CIA formulation, and discharge summaries; and (3) identify any under-, over-, and/or inefficient use of services or resources.
  3. Reports findings to appropriate disciplines and/or committees; notifies appropriate staff members of any deficiencies noted so corrective actions can be taken in a timely manner; submits monthly report to PI Coordinator of findings and actions recommended to correct identified problems.
  4. Coordinates flow of communication between physicians/staff and third party payers concerning reimbursement requisites
  5. Attends mini-treatment team and morning status meetings each weekday to obtain third-party payer pre-certification and ongoing certification requirements and to share with those attending any pertinent data from third-party payer contracts.
  6. Attends weekly treatment team.
  7. Conducts telephone reviews to, and follows through with documentation requests from third party payers.
  8. Maintains abstract with updates provided to third party payers.
  9. Notifies physicians/staff/patients of reimbursement issues.
  10. Initiates and completes appeals process for reimbursement denials; notifies inpatients of denials received.
  11. Reports monthly all Hospital Issued Notices of Non-coverage (HINN letter) to QIO.
  12. Conducts special retrospective studies/audits when need is determined by M&PS and /or other committee structure.
  13. Ensures all authorization and denied information is in HCS at the end of each business day.
  14. Performs other duties and projects as assigned.

Requirements
Educational / Experience Requirements:
  • Associate's Degree with emphasis on healthcare or Bachelor's degree in social services field preferred.
  • At least one year psychiatric/chemical dependency experience with good working psychiatric/medical knowledge.

Qualifications/Skills:
  • Must have excellent assertive communication skills.
  • Knowledge and in-depth understanding of CD-psych treatment and discharge planning process.
  • Must have good writing and composition skills.
  • Must have good understanding of regulatory and fiscal reimbursement and utilization review as a primary component of patient care.
  • Must demonstrate strong patient advocacy skills.
  • Must be able to organize and prioritize high volume workload.
  • Must be able to analyze and utilize data and systems to provide individualized quality treatment in a cost-effective manner.
  • Must be able to function with minimal supervision.
  • Therapeutic Intervention De-escalation Education required.
  • Must have ability to maintain overall good work attitude and interact cooperatively and professionally with other staff members and third party payers to achieve mutually beneficial outcome.
  • Must possess basic competency in age, disability, and cultural diversity for needs of patients served and ability to relate to patients in a manner sensitive to those needs.
  • Must successfully complete CPR certification and an Oceans approved behavioral health de-escalation program.

Work Environment:
Subject to many interruptions. Occasional pressure due to multiple calls and inquiries. This position can be high paced and stressful; must be able to cope mentally and physically to atmosphere. Work requires spending approximately 90% or more of the time inside a building that offers protection from weather conditions but not necessarily from temperature changes.

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