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Manager Utilization Management Jobs in Oklahoma (NOW HIRING)

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Manager Utilization Management information

What does a manager utilization management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.

What are the key skills and qualifications needed to thrive as a manager utilization management?

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

What are some common challenges faced by a manager utilization management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

What is the difference between Manager Utilization Management vs Utilization Review Nurse?

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

What are the most commonly searched types of Utilization Management jobs in Oklahoma?

The most popular types of Utilization Management jobs in Oklahoma are:

What are popular job titles related to Manager Utilization Management jobs in Oklahoma?

For Manager Utilization Management jobs in Oklahoma, the most frequently searched job titles are:

What job categories do people searching Manager Utilization Management jobs in Oklahoma look for?

The top searched job categories for Manager Utilization Management jobs in Oklahoma are:

What cities in Oklahoma are hiring for Manager Utilization Management jobs?

Cities in Oklahoma with the most Manager Utilization Management job openings:

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Oklahoma as of August 2026, with employment types broken down into 84% Full Time, and 16% Contract. Highlights an 100% In-person job distribution.

Medical Management - Utilization Management RN

CommunityCare

Tulsa, OK • On-site

Other

Re-posted 27 days ago

Job description

JOB SUMMARY:
Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high risk members, and other members identified with at risk or high utilization needs. Functions as an active team member of the Utilization Management Team.
KEY RESPONSIBILITIES:
  • Performs utilization review of outpatient and ancillary services as well as inpatient and post-acute services when indicated.
  • Determines medical necessity and appropriateness of services using clinical review criteria.
  • Accurately documents all review determinations and contacts providers and members according to established timeframes.
  • Appropriately identifies and refers cases that do not meet established clinical criteria to the Medical Director.
  • Appropriately identifies and refers quality issues to Medical Management leadership.
  • Appropriately identifies potential cases for Care Management programs.
  • Collaborates with physicians and other providers to facilitate provision of services throughout the health care continuum.
  • Performs accurate data entry.
  • Communicates appropriate information to other staff members as necessary/required.
  • Participates in continuing education initiatives.
  • Collaborates with other departments as needed.
  • Performs other duties as assigned.
QUALIFICATIONS:
  • Knowledge of managed care and associated group benefit plans.
  • Possess strong oral and written communication skills.
  • Ability to reason logically and to use good judgment when interpreting materials or situations.
  • Knowledge of community- based resources.
  • Must have excellent organizational skills and be able to perform multiple tasks.
  • Proficient in Microsoft applications.
  • Excellent time management and documentation skills.
  • Successful completion of Health Care Sanctions background check.
EDUCATION/EXPERIENCE:
  • Graduation from accredited School of Nursing.
  • Current, active, unrestrictive license to practice as a Registered Nurse in the State of Oklahoma.
  • Three years of acute care experience preferred.
  • Two years of experience working with population health preferred.
  • Previous discharge planning or case management experience preferred.
  • Managed care experience a plus.

CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

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