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Remote Utilization Review Manager Jobs in Oklahoma

Management Analyst

Oklahoma City, OK · On-site +1

$35 - $40/hr

... utilization, and program performance. Supervisory Responsibilities : No Job Classification ... Remote / Virtual Travel: Travel up to 50% Compensation: This pay band reflects Chloeta's good faith ...

Tax Manager

Oklahoma City, OK · On-site +1

$125K - $200K/yr

Tax Manager - Public Accounting | Hybrid or Remote Overview: A top-tier public accounting firm is ... Lead client engagements, including planning, budgeting, and supervising tax preparation and review ...

Showing results 21-40

Remote Utilization Review Manager information

What is a remote utilization review manager?

A Remote Utilization Review Manager is a healthcare professional responsible for overseeing the review of medical services and determining the necessity, appropriateness, and efficiency of those services from a remote location. They ensure that healthcare providers comply with guidelines and that patients receive appropriate care without unnecessary procedures. These managers work with clinical teams, insurance companies, and regulatory agencies to optimize patient outcomes and manage healthcare costs. Working remotely allows them to perform these duties using digital health records and telecommunication tools.

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

To thrive as a Remote Utilization Review Manager, you need expertise in healthcare management, case review, and regulatory compliance, typically supported by a nursing degree (RN or BSN) and relevant certifications such as CCM or URAC. Familiarity with utilization management software, electronic health records (EHRs), and payer systems is essential. Strong analytical thinking, attention to detail, and excellent communication skills help navigate complex cases and collaborate with clinical teams and insurers. These skills ensure effective resource utilization, regulatory adherence, and optimal patient outcomes in a remote healthcare environment.

What are some common challenges faced by a remote utilization review manager, and how can they be addressed?

A Remote Utilization Review Manager often encounters challenges such as maintaining effective communication with clinical teams, ensuring timely and accurate reviews, and staying updated with changing regulations and payer requirements. To address these, it's important to leverage secure collaborative platforms, establish clear workflows, and participate in ongoing training. Building strong relationships with team members and regularly reviewing protocols also help in overcoming remote work hurdles and ensuring compliance and efficiency.

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

AspectRemote Utilization Review ManagerRemote Utilization Review Nurse
CredentialsTypically requires a nursing license, certifications like URAC or AAPC, and management experienceLicensed Registered Nurse (RN) with utilization review certification often preferred
Work EnvironmentOversees review teams, manages processes, and ensures compliance remotelyPerforms case reviews, assesses medical necessity, and documents findings remotely
Employer & Industry UsageHealth insurance companies, third-party administrators, healthcare organizations

The Remote Utilization Review Manager focuses on overseeing review teams and managing processes, while the Remote Utilization Review Nurse conducts case assessments and medical necessity reviews. Both roles require nursing credentials and are integral to healthcare utilization management, but differ in responsibilities and leadership levels.

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

The most popular types of Remote Utilization Review jobs in Oklahoma are:

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

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

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

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

What cities in Oklahoma are hiring for Remote Utilization Review Manager jobs?

Cities in Oklahoma with the most Remote Utilization Review Manager job openings:

Agile Project Manager 2- Enterprise Service Delivery

Choctaw Nation of Oklahoma

Durant, OK • On-site, Remote

Full-time

Re-posted 22 days ago


Choctaw Nation Of Oklahoma rating

7.0

Company rating: 7.0 out of 10

Based on 106 frontline employees who took The Breakroom Quiz

664th of 849 rated public administrative organizations


Job description

Full Time| Monday-Friday 8:00AM-4:30PM| Hybrid 60/40 onsite/remote after 90 days 

Weekly Earned Wage Access is an option for this position. 

Job Purpose or Objective(s): The Agile Project Manager leads the team to successful delivery through servant leadership, facilitation, and continuous improvement. They remove obstacles, promote team unity using Scrum practices, and support the creation of clear metrics for leadership reporting. They apply Agile expertise and software development experience to provide daily value to the team.

Primary Tasks:

1. Guide software development team through Agile Scrum framework using best practices and techniques 

2. Access Scrum maturity level of the team and organization and identify techniques to increase proficiency, effectiveness, and utilization 

3. Lead all Scrum activity such as: Daily Stand-ups, Sprint Planning, Sprint Review 

4. Coordinates project activities by preparing key documents, facilitating crossfunctional and steering committee meetings, and managing overall planning, scheduling, task assignments, and status reporting. 

5. Influence immediate team regarding assigned tasks. 

6. Build strong working relationships with team members, department heads and other various stakeholders, including vendors, customers, and peers. 

7. Manage activities of small-medium project teams and one or more projects of small-medium size, scope, and complexity, which may include consultants or 3rd party vendors, controlling the indirect management of resources and schedules to ensure timely completion. 

8. Provide detailed project reports with in-depth analysis including project status, risks, and issues to support findings for upper leadership and strategic partners. 

9. Identifies and resolves routine issues using professional concepts while adhering to company policies, standard practices, and procedures, receives guidance on resolving conflicts between competing projects and aligns work to achieve departmental goals. 

10. Other duties as assigned.

Requirements:

Bachelor's degree or 4 years related work experience 

3 years additional relevant experience 

Good understanding of software development (developer, tester, designer, analyst) 

Good understanding of Agile techniques such as: User stories, Continuous Integrations, Continuous and Automated testing 

Good knowledge of Azure DevOps or other Agile management tools 

Good knowledge of servant leadership, facilitation, conflict resolution, continuous improvement practices 

Good understanding of project management 

Good understanding of business analysis Basic knowledge of IT concepts, strategies, architectures and technical standards 

Good communication 

Self-driven and motivated 

Scrum Master or Agile Certification required

Bachelor's degree or 4 years related work experience 

3 years additional relevant experience 

Good understanding of software development (developer, tester, designer, analyst) 

Good understanding of Agile techniques such as: User stories, Continuous Integrations, Continuous and Automated testing 

Good knowledge of Azure DevOps or other Agile management tools 

Good knowledge of servant leadership, facilitation, conflict resolution, continuous improvement practices 

Good understanding of project management 

Good understanding of business analysis Basic knowledge of IT concepts, strategies, architectures and technical standards 

Good communication 

Self-driven and motivated 

Scrum Master or Agile Certification required

1. Guide software development team through Agile Scrum framework using best practices and techniques 

2. Access Scrum maturity level of the team and organization and identify techniques to increase proficiency, effectiveness, and utilization 

3. Lead all Scrum activity such as: Daily Stand-ups, Sprint Planning, Sprint Review 

4. Coordinates project activities by preparing key documents, facilitating crossfunctional and steering committee meetings, and managing overall planning, scheduling, task assignments, and status reporting. 

5. Influence immediate team regarding assigned tasks. 

6. Build strong working relationships with team members, department heads and other various stakeholders, including vendors, customers, and peers. 

7. Manage activities of small-medium project teams and one or more projects of small-medium size, scope, and complexity, which may include consultants or 3rd party vendors, controlling the indirect management of resources and schedules to ensure timely completion. 

8. Provide detailed project reports with in-depth analysis including project status, risks, and issues to support findings for upper leadership and strategic partners. 

9. Identifies and resolves routine issues using professional concepts while adhering to company policies, standard practices, and procedures, receives guidance on resolving conflicts between competing projects and aligns work to achieve departmental goals. 

10. Other duties as assigned.


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About Choctaw Nation of Oklahoma

Sourced by ZipRecruiter

The Choctaw Nation of Oklahoma, based in Durant, OK, US, is a federally recognized Native American tribe with a strong tribal government. With a community totaling over 200,000 members spread across the United States, the Nation’s industry range is expansive, encompassing healthcare, education, and social services as well as commercial enterprises such as gaming, hospitality, manufacturing, retail, and more. Established in 1834 after the forced relocation known as the Trail of Tears, the Choctaw Nation has a rich history guided by its mission to enhance the lives of all members through opportunities designed to develop healthy, successful, and productive lifestyles.

Industry

Public administration

Company size

10,000+ Employees

Headquarters location

Durant, OK, US

Year founded

2015

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