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Director Optum Utilization Review Jobs (NOW HIRING)

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

Collaborate with Medical Directors for complex cases, denial recommendations, and clinical ... Utilization Management (UM) * Medical Necessity Review * Prior Authorization * Precertification

UHS

DIR - UTILIZATION REVIEW / MGMT

Springfield, IL · On-site

$37.55 - $56.33/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

The Director of Case Management (Utilization Management) is responsible for the leadership ... Ensure timely and accurate utilization review activities and payer communications. * Monitor ...

KPC Health

Utilization Review Tech

Santa Ana, CA · On-site

Performs administrative duties for the Utilization Management Department, and directed in several ... Answer and review pertinent insurance correspondence to ensure complete and accurate reimbursement ...

KPC Global MSO

Utilization Review Tech

Santa Ana, CA · On-site

Reviews treatment plans and status of approvals from insurers. Collects and compiles data as ... Performs administrative duties for the Utilization Management Department, and directed in several ...

Wesley Medical Center

RN - Utilization Review

Tuba City, AZ · On-site

$2.5K/wk

  • Medical

  • Dental

  • Vision

  • Retirement

This is a RN position in the Utilization Review RN Unit. You must have a Nursing License and at ... Weekly Direct Deposit Qualifications * At least 2-years total experience in your specialty

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Director Optum Utilization Review information

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$18K

$52.3K

$84K

How much do director optum utilization review jobs pay per year?

As of Aug 18, 2026, the average yearly pay for director optum utilization review in the United States is $52,322.00, according to ZipRecruiter salary data. Most workers in this role earn between $40,000.00 and $60,000.00 per year, depending on experience, location, and employer.

What is the difference between Director Optum Utilization Review vs Utilization Review Manager?

AspectDirector Optum Utilization ReviewUtilization Review Manager
CertificationsTypically requires certifications like CCM or URAC accreditationOften requires similar certifications, may vary by employer
Work EnvironmentWorks within Optum or similar healthcare organizations, overseeing utilization review processesManages utilization review teams, often within healthcare providers or insurance companies
ResponsibilitiesStrategic oversight of utilization review policies, compliance, and team leadershipSupervises daily review operations, staff management, and process improvements

The main difference is that the Director Optum Utilization Review typically holds a higher strategic leadership role within Optum, focusing on policy and compliance, while the Utilization Review Manager manages daily operations and staff. Both roles require similar credentials but differ in scope and level of responsibility.

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Director Optum Utilization Review jobs near you
Infographic showing various Director Optum Utilization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $52,322 per year, or $25.2 per hour.

Utilization Review Nurse

US Tech Solutions

Canton, MA • On-site

$55 - $60/hr

Other

Posted 9 days ago

Job description

$55-$60 per hour

Canton, MA

Contract

Duration: 6 Month Contract (Possibility of Extension)

Position Overview

We are seeking an experienced Utilization Management (UM) Registered Nurse to support outpatient utilization review and prior authorization activities for a leading healthcare organization. The ideal candidate will have a strong background in managed care, utilization management, medical necessity review, prior authorization, and outpatient clinical review.

This role is responsible for reviewing medical records, evaluating the medical necessity of requested services using established clinical guidelines, collaborating with physicians and healthcare providers, and ensuring timely authorization decisions while maintaining compliance with regulatory standards.

Key Responsibilities

  • Perform outpatient utilization management (UM) and medical necessity reviews for prior authorization and precertification requests.

  • Review clinical documentation and determine benefit eligibility using evidence-based clinical guidelines and health plan policies.

  • Evaluate requests for outpatient procedures, surgeries, imaging, therapies, specialty medications, and other healthcare services.

  • Ensure all utilization review activities meet regulatory turnaround time requirements.

  • Collaborate with Medical Directors for complex cases, denial recommendations, and clinical escalations.

  • Communicate authorization decisions with physicians, provider offices, hospitals, and healthcare facilities.

  • Participate in appeal reviews and provide clinical recommendations when appropriate.

  • Maintain accurate documentation within utilization management systems.

  • Monitor cases for quality, compliance, and adherence to organizational policies.

  • Identify opportunities for process improvement and contribute to quality initiatives.

  • Serve as a clinical resource for internal teams regarding utilization management guidelines and medical necessity criteria.

Required Qualifications

  • Active, unrestricted Registered Nurse (RN) license.

  • Associate Degree in Nursing (ADN) required.

  • Minimum 5 years of RN clinical experience.

  • Minimum 3-5 years of Utilization Management (UM), Case Management, Prior Authorization, or Medical Management experience.

  • Previous Managed Care, Health Plan, Medicare, Medicaid, or Commercial Insurance experience.

  • Strong knowledge of:

  • Utilization Management (UM)

  • Medical Necessity Review

  • Prior Authorization

  • Precertification

  • InterQual and/or MCG Guidelines

  • Experience reviewing outpatient clinical services.

  • Excellent clinical assessment and critical thinking skills.

  • Strong communication skills with providers and interdisciplinary teams.

  • Ability to work independently in a remote environment.

  • Comfortable using multiple systems while managing a high-volume workload.

Preferred Qualifications

  • BSN preferred.

  • Experience with outpatient utilization management.

  • Experience using InterQual and/or MCG clinical criteria.

  • Experience with Medicare Advantage or Commercial Health Plans.

  • Previous experience with appeals, grievances, or denial reviews.

  • Knowledge of NCQA, CMS, and utilization management regulatory requirements.

Note:

  • Candidates can be remote but must have an active unrestricted Massachusetts RN License

About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

AI Statement: By applying, you acknowledge that AI-assisted tools may be used during hiring.

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About US Tech Solutions

Sourced by ZipRecruiter

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.

Industry

It services

Company size

1,001 - 5,000 Employees

Headquarters location

Jersey City, NJ, US

Year founded

2000

Social media

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