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From Home Optum Utilization Review Jobs (NOW HIRING)

ECU Health

Utilization Review Specialist

Greenville, NC · On-site

$65K - $95K/yr

Position Summary The Utilization Review Specialist will ensure regulatory compliance with CMS ... If ADN must have 5 + years experience in an acute care hospital; home health agency; commercial ...

Miami Jewish Health

Utilization Review Nurse

Miami, FL · On-site

... LTACH), home health, DME, and outpatient services. * Applies evidence-based criteria (e.g ... Graduate from an accredited Nursing program. Experience * 2-4 years of experience in healthcare ...

ARcare

Utilization Review Associate

Augusta, AR · On-site

Utilization Review Associate Job Type: Full-time, 40 hours per week required (hourly POSITION ... That mission drives everything we do, from accepting every patient, regardless of insurance status ...

UHS

Utilization Review Clinician

Augusta, GA

... apart from many other treatment facilities, and our tenured team includes seasoned medical staff ... Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case ...

UHS

Utilization Review Clinician

Augusta, GA

... apart from many other treatment facilities, and our tenured team includes seasoned medical staff ... Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case ...

KPC Health

Utilization Review Tech

Santa Ana, CA · On-site

Utilization Review Technician Under direction of the Utilization Review Technician Supervisor, the ... Reviews treatment plans and status of approvals from insurers. Collects and compiles data as ...

UHS

Utilization Review Clinician

Augusta, GA · On-site

... apart from many other treatment facilities, and our tenured team includes seasoned medical staff ... Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case ...

PARKSIDE INC

Utilization Review Specialist

Tulsa, OK · On-site

The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to limit possible recoupment from third party pay sources including Medicare, Medicaid, HMO or private ...

ARcare

Utilization Review Associate

Augusta, AR

Utilization Review Associate Job Type: Full-time, 40 hours per week required (hourly POSITION ... That mission drives everything we do, from accepting every patient, regardless of insurance status ...

UHS

Utilization Review Coordinator

Brookline, MA · On-site

Responsibilities Utilization Review Coordinator Opportunity - HRI Hospital is seeking a Full-time ... From Fortune, ©2025, 2026 Fortune Media IP Limited. All rights reserved. Used under license.

UHS

Utilization Review Coordinator

Brookline, MA · On-site

Responsibilities Utilization Review Coordinator Opportunity - HRI Hospital is seeking a Full-time ... From Fortune, ©2025, 2026 Fortune Media IP Limited. All rights reserved. Used under license.

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 ... Graduation from an accredited school of nursing and five (5) years of acute hospital clinical ...

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How much do from home optum utilization review jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for from home 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 the difference between From Home Optum Utilization Review vs From Home Medical Coder?

AspectFrom Home Optum Utilization ReviewFrom Home Medical Coder
CredentialsTypically requires healthcare-related certifications (e.g., RN, LPN, or medical reviewer credentials)Certification in medical coding (e.g., CPC, CCS) often required
Work EnvironmentRemote, healthcare insurance or managed care settingRemote, healthcare billing and coding environment
Industry UsageCommon in health insurance, managed care, and utilization managementCommon in medical billing, coding, and healthcare documentation

From Home Optum Utilization Review and From Home Medical Coder roles both operate remotely within the healthcare industry. However, utilization review focuses on assessing medical necessity and approving or denying services, requiring clinical credentials. Medical coders translate healthcare documentation into standardized codes, primarily needing coding certifications. Both roles are essential in healthcare operations but differ in responsibilities and required qualifications.

What cities are hiring for From Home Optum Utilization Review jobs? Cities with the most From Home 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 From Home Optum Utilization Review jobs? States with the most job openings for From Home Optum Utilization Review jobs include:
From Home Optum Utilization Review jobs near you

Utilization Review Specialist

ECU Health

Greenville, NC • On-site

$65K - $95K/yr

Full-time

Re-posted 19 days ago

ECU Health rating

7.1

Company rating: 7.1 out of 10

Based on 134 frontline employees who took The Breakroom Quiz

378th of 887 rated healthcare providers

Job description

Position Summary
The Utilization Review Specialist will ensure regulatory compliance with CMS Conditions of Participation with regard to Utilization Management. Perform Utiliztion Review according to CMS and commercial payor guidelines. Participate in denial / appeal process.
Responsibilities
  • Utilization Management. Utilizes the nursing process to assess, plan, implement and evaluate the utilization management needs for patients in assigned caseload. Performs utilization management activities using approved screening criteria.
  • Provides follow up with appropriate resource for utilization management issues/non-compliance.
  • Clinical Progression and Utilization Management. Participates in quality improvement (QI) activities.
  • Advances knowledge and skills in case / utilization management.
  • Collaborates effectively with departmental staff to achieve goals and objectives.
Minimum Requirements
Associates Degree in Nursing or higher required. NC RN licensure required.
If ADN must have 5 + years experience in an acute care hospital; home health agency; commercial insurance company; case management.
If BSN must have 3-5 years experience in an acute care hospital; home health agency; commercial insurance company; case management.
A certification in Case Management (i.e. CCM, ACM) can substitute for 1 year of experience; Masters Degree in health related field can substitute for 1 year of experience.
Pay Range
$65520.00 - $95501.12
Other Information
Shift: Monday- Friday. Day shift with alternate holiday rotation
On-site
ECU Health
About ECU Health Medical Center
ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.
General Statement
It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.
Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.
We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant's qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.

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