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Commission Optum Utilization Review Jobs (NOW HIRING)

Discovery Institute

Utilization Review

Marlboro, NJ · On-site

Position Summary The Utilization Review (UR) Specialist is responsible for obtaining and ... Ensure compliance with Joint Commission, state, federal, and payer regulations. * Maintain ...

Tuba City Regional

Utilization Review

Tuba City, AZ · On-site

Utilization Review Nurse City/State: Tuba City, Arizona Shift: Monday - Friday from 8am - 5pm ... Ensure compliance with CMS and Joint Commission requirements. * Contribute to reporting and quality ...

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

Strong knowledge of Joint Commission and CMS guidelines Why Apply * Competitive pay * Stable, high-demand role * Collaborative healthcare environment Apply Now If you have strong Utilization Review ...

Banyan

Utilization Review Specialist

Pompano Beach, FL · On-site

$50K - $65K/yr

Utilization Review Specialist | Remote | Full-Time $50,000 - $65,000 Annually | Weekdays (Weekend ... Nationally recognized organization - Joint Commission-accredited, with 18 locations and telehealth ...

Global Force

Utilization Review Nurse

Las Vegas, NV · On-site

About the job Utilization Review Nurse Sign on bonus may apply up to $15,000 Position Summary ... Joint Commission Accredited Health care Organizations standards, state statutes governing hospital ...

Mission Hospital

RN - Utilization Review

Tuba City, AZ · On-site

$2.5K/wk

Ensure that utilization review practices comply with regulatory standards, including The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS), and other state or federal regulations ...

MNCP Staffing

Utilization Review Nurse

Las Vegas, NV

Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance ... Joint Commission Accredited Health care Organizations standards, state statutes governing hospital ...

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How much do commission optum utilization review jobs pay per hour?

As of Aug 15, 2026, the average hourly pay for commission optum utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.
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Commission Optum Utilization Review jobs near you
Infographic showing various Commission Optum Utilization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review

Discovery Institute NJ

Marlboro, NJ • On-site

Other

Posted 23 days ago

Job description

Position Summary
The Utilization Review (UR) Specialist is responsible for obtaining and maintaining insurance authorizations for clients receiving substance use disorder treatment services. This position works closely with clinical staff, admissions, and insurance companies to ensure medical necessity documentation is accurate, authorizations are obtained timely, and reimbursement is maximized while maintaining compliance with payer requirements, Medicaid regulations, and accreditation standards.
Essential Duties and Responsibilities

  • Obtain initial and concurrent insurance authorizations for all levels of care.
  • Review clinical documentation to ensure it supports medical necessity.
  • Submit clinical information to insurance companies within required timeframes.
  • Monitor authorization expiration dates and request extensions before expiration.
  • Communicate authorization decisions and payer requirements to clinical staff.
  • Track approved days and notify leadership of denials or reductions in care.
  • Prepare and submit appeals for denied services when appropriate.
  • Maintain accurate authorization records in the electronic health record (EHR).
  • Work collaboratively with Admissions, Clinical, Nursing, and Billing departments.
  • Verify insurance benefits and coverage when necessary.
  • Monitor payer portals for authorization updates.
  • Assist with Medicaid and managed care authorization processes.
  • Participate in utilization review meetings and case conferences.
  • Generate reports on authorization status, denials, appeals, and payer trends.
  • Ensure compliance with Joint Commission, state, federal, and payer regulations.
  • Maintain confidentiality in accordance with HIPAA regulations.
  • Perform other duties as assigned.
Qualifications
  • High school diploma required; Associate's or Bachelor's degree preferred.
  • Minimum of two years of utilization review, case management, medical billing, or behavioral healthcare experience preferred.
  • Experience in substance use disorder or behavioral health treatment strongly preferred.
  • Knowledge of ASAM Criteria preferred.
  • Familiarity with Medicaid, commercial insurance, and managed care plans.
  • Strong organizational and time management skills.
  • Excellent verbal and written communication skills.
  • Ability to prioritize multiple cases in a fast-paced environment.
  • Proficient in Microsoft Office and electronic health record systems.
Knowledge, Skills, and Abilities
  • Understanding of insurance authorization processes.
  • Knowledge of medical necessity criteria and documentation standards.
  • Strong analytical and critical thinking skills.
  • Excellent customer service and professional communication.
  • Ability to work independently while collaborating with interdisciplinary teams.
  • Attention to detail and accuracy.
  • Ability to maintain confidentiality.
Performance Expectations
  • Maintain timely insurance authorizations with minimal lapses.
  • Reduce avoidable authorization denials.
  • Ensure documentation meets payer standards.
  • Maintain accurate records and reporting.
  • Demonstrate professionalism, teamwork, and excellent customer service.
  • Comply with all organizational policies, HIPAA, Joint Commission standards, and applicable federal and New Jersey regulations.

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