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Remote Utilization Management Jobs in Oklahoma (NOW HIRING)

Chloeta

Management Analyst

Oklahoma City, OK · On-site +1

$35 - $40/hr

Remote / Virtual Travel: Travel up to 50% Compensation: This pay band reflects Chloeta's good faith ... utilization. * Prepare project schedules, milestone reports, status reports, dashboards, and ...

CSAA

Marketing Engagement Partner - Remote

Kansas, OK · Remote

... management review * Lead operational governance activities across assigned Clubs, including ... Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements

NOV, Inc.

Sr. Operations Manager

Yukon, OK · Remote

... quality, utilization, customer retention, revenue growth, and profitability. * Establish and ... Progressive leadership experience in operations management, technical services, remote operations ...

National Oilwell Varco

Sr. Operations Manager

Yukon, OK · Remote

... quality, utilization, customer retention, revenue growth, and profitability. * Establish and ... Progressive leadership experience in operations management, technical services, remote operations ...

Aggreko

Project Manager AES

Oklahoma City, OK · Remote

$115K - $140K/yr

Proficiency with CRM (i.e., Salesforce). * Adept at optimizing resource utilization, forecasting ... Remote opportunity located in any city with a major airport located in the United States * Work ...

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Remote Utilization Management information

How does a Remote Utilization Management professional typically collaborate with healthcare providers and insurance teams?

Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.

What are the key skills and qualifications needed to thrive as a Remote Utilization Management Nurse, and why are they important?

Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.

What is remote utilization management?

Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.

What is the difference between Remote Utilization Management vs Remote Case Management?

AspectRemote Utilization ManagementRemote Case Management
CredentialsRN, LPN, or licensed healthcare professionalsRN, LPN, or social workers
Work EnvironmentHealthcare facilities, insurance companies, telehealthHealthcare providers, insurance, community agencies
Industry UsageInsurance, healthcare, telehealthHealthcare, social services, insurance
Primary FocusReviewing medical necessity, authorizationsCoordinating patient care, support services

Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.

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 Remote Utilization Management jobs in Oklahoma? For Remote Utilization Management jobs in Oklahoma, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management jobs in Oklahoma look for? The top searched job categories for Remote Utilization Management jobs in Oklahoma are:
What cities in Oklahoma are hiring for Remote Utilization Management jobs? Cities in Oklahoma with the most Remote Utilization Management job openings:
Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Oklahoma as of July 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution.
Manager, Utilization Management (51741)

Manager, Utilization Management (51741)

GLOBALHEALTH HOLDINGS LLC

Oklahoma City, OK • On-site, Remote

Full-time

Medical

Posted 27 days ago

Job description

WHO WE ARE:
GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.
WHO YOU ARE:
This position, under the guidance of the Vice President, Health Services is responsible for the operational oversight of the Utilization Management department. This includes tracking and trending of utilization data, development and update of policy and procedures, regulatory reporting and supervisory staff. The position also may include collaboration with internal teams and external providers.
ESSENTIAL DUTIES AND RESPONSBILITIES:
  • Accountable for the functions of the Utilization Management department.
  • Develops and oversees policies and procedures, regulatory reporting and clinical practice guidelines.
  • Integrates quality improvement activities within utilization management.
  • Communicates regularly with employees through participation in regular staff meetings to share information appropriate to their job functions and development.
  • Serves as a resource to both lines of business in relation to Utilization Management.
  • Plays an active role in both internal and external committees along with contract delegated responsibilities.
  • Collaborates with network facilities to improve concurrent and discharge plans for our members.
  • Performs retrospective review for the claims department.
  • Assists in providing information for the appeals department.
  • Provides information to reinsurance for members pending transplantation.
  • Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.

EDUCATION AND EXPERIENCE:
  • Current Oklahoma state RN license
  • Experience in Managed Care, Case Management and Concurrent Review
  • Previous experience in a supervisory role
  • CPHQ, CPUR and previous insurance experience preferred

KNOWLEDGE, SKILLS AND ABILITIES:
  • Ability to communicate, both orally and written, and manage complex working relationships.
  • Excellent organizational, leadership, problem-solving, and decision-making skills.
  • Knowledge of Microsoft software programs including Word, Excel, PowerPoint and Power BI
  • Knowledge of quality improvement and utilization management

WORK ENVIRONMENT:
Current work environment is remote, however, some state exclusions apply.
Must have access to a reliable and secured internet connection source. Work environment must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. This position will also be required to use reasonable and necessary safeguards to protect GlobalHealth records from unauthorized access, disclosure or damage and will adhere to all GlobalHealth privacy and security policies.
TRAVEL:
Travel may be required for this position
SUPERVISORY RESPONSIBILITY:
This position is in a supervisory role over Utilization Management leadership and staff
OTHER DUTIES:
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

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