Optical parametric oscillation in a Kerr nonlinear microresonator can generate coherent laser light with frequencies that are widely separated from the pump frequency, allowing, for example, visible light to be generated using a near-infrared pump. To be practically useful, the pump-to-signal conversion efficiency must be far higher than what has been demonstrated in microresonator-based oscillators with widely separated output frequencies. To address this challenge, here we theoretically and numerically study parametric oscillations in Kerr nonlinear microresonators, revealing an intricate solution space that arises from an interplay of nonlinear processes. As a start, we use a three-mode approximation to derive an efficiency-maximizing relation between pump power and frequency mismatch. However, realistic devices, such as integrated microring resonators, support far more than three modes. Hence, a more accurate model that includes the entire modal landscape is necessary to determine potential inefficiencies arising from unwanted competing nonlinear processes. To this end, we numerically simulate the Lugiato-Lefever equation that accounts for the full spectrum of nonlinearly coupled resonator modes. We observe and characterize two nonlinear phenomena linked to parametric oscillations in multimode resonators: mode competition and cross-phase modulation-induced modulation instability. Both processes may impact conversion efficiency. Finally, we show how to increase the conversion efficiency to approximately 25% by tuning the microresonator loss rates. Our analysis will guide microresonator designs that aim for high conversion efficiency and output power.