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From Home Optum Utilization Review Jobs (NOW HIRING)

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 ...

TEKsystems

Utilization Review Specialist

Addison, TX

$70K - $100K/yr

Utilization review experience Additional Skills & Qualifications * Perform utilization review ... Have Benefits from a few years ago. Need updated copy. Workplace Type This is a hybrid position in ...

UHS

Utilization Review Clinician

Augusta, GA · On-site

Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case ... From Fortune, ©2025, 2026 Fortune Media IP Limited. All rights reserved. Used under license.

UHS

Utilization Review Clinician

Augusta, GA

Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case ... From Fortune, ©2025, 2026 Fortune Media IP Limited. All rights reserved. Used under license.

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 ...

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 ...

Hired by Matrix

RN Utilization Review

Portales, NM · On-site

... for Home Health Care, CME, SNF, acute rehab and appointments. * Educates physicians and staff ... We want to hear from you! If you think you'd be a good match, submit your resume and reach out to ...

AbsoluteCare

Utilization Review Nurse

New Orleans, LA · On-site

... suffer from behavioral health, substance use, and SDoH challenges. We use population health ... home nursing as well as others. Ensures medically appropriate, high quality, cost effective care ...

Albany Medical Center

Utilization Review Nurse

Albany, NY · On-site

$77K - $119K/yr

... home care in a high volume, acute care hospital preferred. PRI and • Case Management ... from unauthorized access and modification. Albany Medical Center is the centerpiece of medicine ...

Medix

Utilization Review Nurse

Orange, CA · On-site

$38 - $53/hr

... from admission through discharge planning. The primary goal is to conduct daily inpatient reviews ... coordinating care for DME, Home Health, and Skilled Nursing Facility (SNF) placements.

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From Home Optum Utilization Review information

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

As of Aug 22, 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.

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From Home Optum Utilization Review jobs near you

Utilization Review Nurse

Global Force

Las Vegas, NV • On-site

Other

Posted 19 days ago

Job description

About the job Utilization Review Nurse
Sign on bonus may apply up to $15,000
Position Summary: Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with third party payer requirements. Duties include analyzing medical charts, determining whether care provided is within established parameters.
Job Requirement
Education/Experience:
Graduation from an accredited school of nursing and five (5) years of acute hospital clinical nursing experience, one (1) year of which was in Utilization Management, Case Management, or Clinical Documentation Improvement.
Licensing/Certification Requirements:
Valid license by the State of Nevada to practice as a Registered Nurse.
Additional Position Requirements

  • Minimum three (3) years of Utilization Management experience.
  • Minimum of three (3) year's experience with discharge planning in an acute care facility.
  • Recent documented experience with InterQual, and ability to pass the InterQual exam.
  • Recent documented experience with Milliman experience.

Knowledge, Skills, Abilities, and Physical Requirements
Knowledge of:
Interquel or Milliman utilization review criteria, Medicare/Medicaid guidelines, hospital policies and procedures; Joint Commission Accredited Health care Organizations standards, state statutes governing hospital services and health care, and other relevant regulations and standards; clinical medical and nursing procedures; disease processes; department and hospital safety practices and principles; patient rights; age specific patient care practices; infection control policies and practices; department and hospital emergency response policies and procedures.
Skill in:
Interpreting patient charts to determine whether care given is within best practice, appropriate for the diagnosis and properly documented; excellent ability to collaborate, co-ordinate and communicate findings; interpreting regulations and standards for others; writing reports, meeting minutes and other technical documents; analyzing statistical and other quantitative data; applying investigative and interviewing techniques; using a computer and a variety of software applications; communicating with a wide variety and establishing interpersonal relationships to interact effectively with co-workers, supervisor, staff in other work units and exchange or convey information.
Physical Requirements and Working Conditions:
Mobility to work in a typical office setting and use standard equipment, stamina to remain seated for extended periods of time, vision to read printed materials and a computer screen, and hearing and speech to communicate effectively in person and over the telephone. Strength and agility to exert up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects. May work shifts and weekends. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this classification.

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