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Evening Optum Utilization Review Jobs (NOW HIRING)

Genoa Telepsychiatry

Utilization Management Nurse RN

$60K - $107K/yr

The nurse will complete their case within the time expectations while providing high quality reviews. The Utilization Management Nurse will perform their job functions, adhering to both Optum and ...

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

As of Aug 23, 2026, the average hourly pay for evening 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.

What is an evening Optum utilization review?

Evening Optum Utilization Review jobs involve evaluating medical records and healthcare services during evening hours to determine if they meet established guidelines for medical necessity, appropriateness, and efficiency. Professionals in this role typically review patient cases, collaborate with healthcare providers, and ensure compliance with insurance or regulatory requirements. These positions are essential for managing healthcare costs and ensuring patients receive appropriate care, often requiring clinical experience and familiarity with utilization management processes.

What are the key skills and qualifications needed to thrive as an evening Optum utilization review?

To thrive as an Evening Optum Utilization Review Nurse, you need a valid RN license, clinical experience, and a solid understanding of utilization management principles. Familiarity with case management software, electronic health records (EHRs), and knowledge of regulatory guidelines such as Medicare and Medicaid are typically required. Strong analytical thinking, attention to detail, and effective communication skills enable you to assess medical necessity and coordinate care efficiently. These competencies ensure accurate and timely reviews, compliance with regulations, and optimal outcomes for both patients and the organization.

What are some common challenges faced by utilization review nurses working evening shifts at Optum, and how can they be addressed?

Utilization Review nurses working evening shifts at Optum often encounter challenges such as limited access to providers or support staff during non-standard hours, which can make obtaining timely information more difficult. Additionally, they may need to manage increased autonomy and prioritize cases with less immediate supervision. To address these challenges, evening UR nurses rely heavily on strong communication skills, proactive documentation, and efficient use of digital tools and resources. Collaboration with daytime teams through thorough handoffs and clear case notes also helps ensure continuity of care and decision-making.

What is the difference between Evening Optum Utilization Review vs Evening Optum Claims Reviewer?

AspectEvening Optum Utilization ReviewEvening Optum Claims Reviewer
Primary RoleAssess medical necessity and appropriateness of care for insurance claimsReview and process insurance claims for accuracy and completeness
CertificationsTypically requires clinical credentials (e.g., RN, LPN, or other healthcare licenses)Usually requires insurance or claims processing certifications
Work EnvironmentHealthcare settings, insurance companies, or third-party administratorsInsurance companies, healthcare payers, or claims processing centers
Industry UsageCommonly used in health insurance and managed careCommon in health insurance and claims processing sectors

Both roles are integral to health insurance operations but focus on different aspects: Utilization Review evaluates the necessity of care, while Claims Review verifies claim accuracy. Understanding these differences helps in choosing the right career path or job focus within the insurance industry.

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Evening Optum Utilization Review jobs near you
Infographic showing various Evening 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 $87,946 per year, or $42.3 per hour.

Utilization Review Specialist

BriteLife Recovery

Englewood, NJ • On-site

Full-time

Re-posted 29 days ago

Job description

) What you will be doing?
The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is responsible for overseeing and coordinating all aspects of utilization review and insurance authorization for clients receiving substance use disorder (SUD) treatment at Britelife Recovery. This role ensures timely approvals and continued stay authorizations from insurance payers by effectively communicating clinical information and advocating for appropriate levels of care.
The UR Specialist works closely with clinical staff, admissions, medical providers, and third-party payers to support patient access to treatment and maintain financial viability for the organization. Success in this role requires strong clinical judgment, documentation skills, familiarity with ASAM criteria, and a working knowledge of insurance guidelines specific to behavioral health
What tasks are required?
  • Conduct initial and concurrent reviews for detox, residential, partial hospitalization (PHP), and intensive outpatient (IOP) levels of care.
  • Obtain prior authorizations and continued stay approvals from commercial and other payers by submitting timely clinical reviews and documentation.
  • Communicate clinical necessity of services based on ASAM criteria and DSM-5 diagnoses.
  • Track and document all insurance-related communications, decisions, and outcomes in the EHR and UR logs.
  • Collaborate with clinicians, therapists, case managers, and medical staff to gather accurate and up-to-date clinical information for reviews.
  • Ensure treatment plans, progress notes, and assessments are completed on time and accurately reflect medical necessity.
  • Participate in multidisciplinary team meetings to stay informed on client progress and treatment goals.
  • Assist staff with proper documentation practices to support insurance justification and compliance.
  • Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols.
  • Monitor trends in denials, approvals, and length-of-stay metrics to support organizational performance improvement.
  • Assist in appeals and peer reviews by gathering required documentation and preparing clinical summaries.
  • Provide training and support to staff on documentation best practices related to utilization review.
  • Special projects as assigned

What we need from you?
  • Minimum of 2-3 years of experience in utilization review, case management, or insurance coordination in a behavioral health or substance use treatment setting.
  • Knowledge of ASAM criteria and levels of care for substance use and co-occurring disorders.
  • Familiarity with managed care principles, insurance authorizations, and payer requirements.
  • Bachelor's degree in Nursing, Social Work, Psychology, or a related field required; advanced degree or licensure (e.g., RN, LCSW, LPC, LMHC, or CADC) preferred.
  • Excellent organizational, communication, and time management skills.
  • Proficiency in Electronic Health Records (EHRs), insurance portals, and Microsoft Office tools.
  • Bachelor's degree in Nursing, Social Work, Psychology, or a related field required; advanced degree or licensure (e.g., RN, LCSW, LPC, LMHC, or CADC) preferred.
  • Experience or working knowledge with Collaborative MD and KIPU
  • Experience in detox and residential SUD programs.
  • Knowledge of major insurance provider platforms (e.g., Optum, Aetna, BCBS, Cigna).
  • Strong clinical writing skills and familiarity with medical necessity language.
  • Ability to advocate for clients while balancing payer relationships and compliance.
  • Ability to lift up to 25 pounds.
  • Ability to walk up and down stairs during emergency drills or situations.

All ARS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. ARS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.

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