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Manager Utilization Management Jobs in Oklahoma (NOW HIRING)

Accenture

Clinical Management Manager

Oklahoma City, OK · On-site

$94K - $293K/yr

Design and implement care delivery models, workflows, and utilization management solutions * Drive measurable improvements in patient flow, capacity, LOS, and avoidable utilization * Partner with ...

New

Accenture

$94K - $293K/yr

Design and implement care delivery models, workflows, and utilization management solutions * Drive measurable improvements in patient flow, capacity, LOS, and avoidable utilization * Partner with ...

New

Healthcare Scouts

Hospital Case Manager

Tulsa, OK · On-site

Responsible for all case management activities assignedm, including case management and utilization management * The Case Manager provides concise management of patients hospitalization from pre ...

Pharmacy Careers

Formulary Management Pharmacist

Tulsa, OK · On-site

$50.50 - $60.75/hr

Provide clinical support for utilization management, prior-authorization criteria, and step-therapy guidelines. What You'll Bring * Education: PharmD or Bachelor of Pharmacy. * Licensure: Active U.S ...

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 ...

Bluestone Physician Services

$68K - $80K/yr

Gaps-in-Care & Utilization Management: Proactively identify and close clinical and documentation gaps to support Value-Based Care (VBC) contracts, including ACO initiatives. Take accountability for ...

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All JobsUtilization Management JobsManager Utilization Management JobsManager Utilization Management Jobs in Oklahoma

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 - Senior Manager Clinical Governance and Performance 145-2056

CommunityCare

Tulsa, OK • On-site

Full-time

Posted 28 days ago

Job description

WORK ARRANGEMENT:
Remote, with occasional travel as needed for meetings, audits, training, or other business requirements.
JOB SUMMARY:
Responsible for leading governance, audit readiness, training, policy and procedure management, corrective action oversight, and performance improvement across Physical Health Utilization Management, Behavioral Health Utilization Management, Pharmacy Utilization Management, and Appeals and Grievances.
Reporting to the Chief Medical Officer, the Director provides centralized leadership for internal and delegated entity auditing, continuous regulatory and accreditation readiness, corrective action monitoring, operational training, process standardization, and alignment of policies and procedures across the assigned functions.
Works closely with clinical and operational leaders to translate Medicare Advantage, Marketplace, state, accreditation, contractual, and organizational requirements into consistent and sustainable operational practices. Serves as the Chief Medical Officer's designated leader for governance and performance activities within the assigned areas and provides leadership to audit, training, administrative support, and process improvement staff.
KEY RESPONSIBILITIES:
  • Lead governance and performance activities across Physical Health UM, Behavioral Health UM, Pharmacy UM, and Appeals and Grievances.
  • Maintain continuous readiness for CMS, Marketplace, state, URAC, delegated oversight, contractual, and internal audits.
  • Develop and oversee risk-based internal and delegated entity audits, including operational and clinical reviews.
  • Establish standardized audit tools, sampling methods, scoring, documentation requirements, reporting, and escalation thresholds.
  • Analyze audit and monitoring results to identify trends, control gaps, training needs, repeat findings, and systemic risk.
  • Oversee corrective action plans, including root cause analysis, accountable owners, remediation timelines, effectiveness monitoring, and closure.
  • Escalate material findings, delayed remediation, repeat deficiencies, and delegate performance concerns to the Chief Medical Officer and appropriate leaders.
  • Oversee onboarding, annual, regulatory, remedial, and role-specific training and monitors completion, competency, and effectiveness.
  • Lead the development, alignment, implementation, and maintenance of policies, desk level procedures, and related operational documents.
  • Monitor regulatory and accreditation changes and coordinates updates to policies, procedures, training, audit tools, and operational practices.
  • Use audit findings, appeals and grievance trends, complaints, overturns, delegate performance, and operational data to identify improvement opportunities.
  • Lead process improvement initiatives and cross-functional workgroups addressing operational, regulatory, and performance concerns.
  • Develop reports and governance updates for the Chief Medical Officer, functional leaders, and applicable committees.
  • Partner with Compliance, Legal, Quality, Contracting, Credentialling, HR, and other departments as appropriate.
  • Provide leadership, performance oversight, and professional development for assigned audit, training, administrative support, and process improvement staff.
  • Perform other related job duties as required or assigned.

QUALIFICATIONS:
  • Demonstrated leadership ability within a health plan, managed care, or similarly regulated health care environment.
  • Strong knowledge of Medicare Advantage and Marketplace regulatory and operational requirements for a health plan.
  • Broad understanding of health plan operations, including utilization management, prior authorization, organization and coverage determinations, appeals, grievances, notices, delegation, and member and provider communications.
  • Demonstrated experience with continuous audit readiness, internal auditing, delegated entity oversight, corrective action planning, policy and procedure management, training, and performance improvement.
  • Ability to interpret complex regulatory, accreditation, contractual, and operational requirements and translate them into practical and sustainable processes.
  • Strong analytical skills with the ability to identify trends, systemic risks, control gaps, root causes, and improvement opportunities.
  • Ability to exercise authority and influence across multiple operational areas while maintaining collaborative relationships with functional leaders.
  • Ability to distinguish regulatory requirements from organizational policy, clinical judgment, and operational preference.
  • Well-developed written, verbal, interpersonal, facilitation, and presentation skills.
  • Strong organizational and project management skills with the ability to manage competing priorities and regulatory deadlines.
  • Ability to respectfully challenge existing practices, escalate concerns appropriately, and facilitate cross-functional resolutions.
  • Demonstrated sound judgment, integrity, accountability, professionalism, and discretion.
  • Successful completion of Health Care Sanctions background check.
  • Successful completion of pre-employment drug testing.
  • Ability to converse and write fluently in English.

EDUCATION/EXPERIENCE:
  • Bachelor's degree in health care administration, business administration, public health, nursing, compliance, pharmacy, quality, or a related field.
  • Minimum of five years of progressive experience in health plan operations, utilization management, appeals and grievances, regulatory operations, auditing, accreditation, delegated oversight, performance improvement, or a related function.
  • Minimum of three years of leadership or supervisory experience, including responsibility for staff performance, development, and accountability.
  • Demonstrated experience supporting or leading CMS, URAC, state, delegated entity, client, or internal audit activities.
  • Demonstrated experience developing or overseeing audit programs, corrective action plans, policies, procedures, training programs, or operational monitoring.
  • Experience with Medicare Advantage program audits, organization determinations, coverage determinations, appeals, grievances, reopening requirements, and delegated oversight strongly preferred.
  • Experience with Marketplace requirements and URAC accreditation audits strongly preferred.
  • Experience leading multidisciplinary teams or functions involving audit, training, policy management, administrative support, or process improvement preferred.
  • Advanced degree or certification in health care administration, compliance, quality, audit, project management, or process improvement preferred.

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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