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Manager Optum Utilization Review Jobs (NOW HIRING)

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL

$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 ...

Mindful Health

Utilization Review Specialist

$25 - $30/hr

Utilization Review Specialist Mindful Health is a fast-growing company with the goal of providing ... Proven time management skills with the ability to meet deadlines consistently * Proficiency in ...

Franciscan Health

Utilization Review Coordinator

Act as a resource person for the case management department regarding payer rules, regulations ... Utilization Review Coordinator $56971.20-$84749.60 INCENTIVE: Not Applicable EQUAL OPPORTUNITY ...

UHS

Utilization Review Coordinator

Augusta, GA

Under the direction of the UR Manager, the Utilization Review Coordinator is responsible for conducting clinical review of data to determine eligibility respective to pre-certification and continued ...

UHS

Utilization Review Coordinator

Augusta, GA

Under the direction of the UR Manager, the Utilization Review Coordinator is responsible for conducting clinical review of data to determine eligibility respective to pre-certification and continued ...

UHS

Utilization Review Manager

Grand Rapids, MI · On-site

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 ...

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 · On-site

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 ...

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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.
Manager, Utilization Review (5052)

Manager, Utilization Review (5052)

REGIONAL ONE HEALTH

Memphis, TN

Full-time

Re-posted 29 days ago

Regional One Health rating

6.4

Company rating: 6.4 out of 10

Based on 36 frontline employees who took The Breakroom Quiz

637th of 881 rated healthcare providers

Job description

Regional One Health is currently seeking a Manager, Utilization Review

A Brief Overview
The Manager, Utilization Review manages the daily operations of the Utilization Review Department and is responsible for overseeing and coordinating utilization review processes within Regional One Health. Utilization Review activities include inpatient, observation, outpatient in a bed, ambulatory surgery, and Point-of-Entry Utilization review/case management activities. This role is crucial in ensuring appropriate utilization of healthcare resources while maintaining high-quality patient care. The Utilization Review Manager works collaboratively with medical and hospital staff to efficiently support and integrate utilization review activities.
What you will do

  • Reports to the Sr. Director on department activities, market changes, and operational opportunities, presenting action plans as necessary.
  • Establishes and maintains an organizational structure and staffing to meet departmental and organizational goals.
  • Develops and implements utilization review policies and procedures in compliance with regulatory requirements and industry best practices.
  • Stay current on changes in healthcare regulations, laws, and policies affecting utilization review.
  • Supervises the utilization review staff, including case managers (Point of Entry) and the utilization review team.
  • Oversees the submission of utilization activities, including ensuring timely and accurate submission of medical necessity reviews, clinical documentation to providers for authorization and concurrent review, and planned surgery authorizations.
  • Conducts periodic reviews of medical records to assess the appropriateness of care and services provided.
  • Assists in developing and managing department budgets and implementing cost containment measures as needed.
  • Participates in quality improvement initiatives, including patient satisfaction surveys and process improvement projects.
  • Communicates utilization review findings and recommendations to hospital administration, medical staff, and other stakeholders.
  • Ensures compliance with best practices and standards related to utilization review metrics and data collection.
  • Oversees staff competencies, training, and development to maintain a highly skilled workforce.
  • Supports leadership in setting department goals, monitoring program effectiveness, and making necessary adjustments based on utilization statistics and cost-benefit analysis.
  • Leads quality improvement initiatives, including audits and mock inspections, to maintain compliance and operational excellence.
  • Ensures timely submission of departmental reports, highlighting findings, recommendations, and action plans.
  • Encourages professional growth and continuous education among team members.
  • Bachelor's Degree in Healthcare Administration or Management Preferred
  • Bachelor's Degree in Nursing (BSN) Preferred
  • Master's Degree Strongly preferred
  • Registered Nurse (RN) Required
  • Minimum 5 years experience Five (5) years’ progressively responsible related experience is required, preferably within a healthcare environment. Required


Physical Demands

  • Standing - Occasionally
  • Walking - Occasionally
  • Sitting - Constantly
  • Lifting - Rarely
  • Carrying - Rarely
  • Pushing - Rarely
  • Pulling - Rarely
  • Climbing - Rarely
  • Balancing - Rarely
  • Stooping - Rarely
  • Kneeling - Rarely
  • Crouching - Rarely
  • Crawling - Rarely
  • Reaching - Rarely
  • Handling - Occasionally
  • Grasping - Occasionally
  • Feeling - Rarely
  • Talking - Constantly
  • Hearing - Constantly
  • Repetitive Motions - Frequently
  • Eye/Hand/Foot Coordination - Frequently


Regional One Health is an equal opportunity employer.

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