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Evening Optum Utilization Review Jobs (NOW HIRING)

She Recruits LLC

Gastroenterology - Chart Review

This is a Full-Time 40 hours a week position No Call, evening or weekend work Work in the comfort ... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ...

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

As of Aug 11, 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 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 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 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.

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.
More about Evening Optum Utilization Review jobs
What cities are hiring for Evening Optum Utilization Review jobs? Cities with the most Evening Optum Utilization Review job openings:
What are the most commonly searched types of Optum Utilization Review jobs? The most popular types of Optum Utilization Review jobs are:
What states have the most Evening Optum Utilization Review jobs? States with the most job openings for Evening Optum Utilization Review jobs include:
What job categories do people searching Evening Optum Utilization Review jobs look for? The top searched job categories for Evening Optum Utilization Review jobs are:
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, 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 Management Nurse Consultant

CVS Health

Harrisburg, PA • On-site

$29.10 - $62.32/hr

Other

Medical, Dental, Vision, Retirement, PTO

Re-posted 13 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,332 frontline employees who took The Breakroom Quiz

89th of 112 rated pharmacies

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.

  • Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.

  • Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care

  • Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs

  • Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization

  • Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

  • Typical office working environment with productivity and quality expectations.

  • Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.

  • Sedentary work involving periods of sitting, talking, listening.

  • Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.

  • Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.

  • Effective communication skills, both verbal and written

Required Qualifications

  • 2+ years of experience as a Registered Nurse in adult acute care/critical care setting

  • Must have active current and unrestricted RN licensure in state of residence

  • Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours

Preferred Qualifications

  • 2+ years of clinical experience required in med surg or specialty area

  • Managed Care experience preferred, especially Utilization Management

  • Preference for those residing in ET zones

Education

Associates Degree required

BSN preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$29.10 - $62.32

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments (https://learn.bswift.com/cvshealth-mainland) .

We anticipate the application window for this opening will close on: 08/18/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.

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