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Full Time Optum Health Utilization Review Jobs (NOW HIRING)

Mindful Health

Utilization Review Specialist

$25 - $30/hr

Utilization Review Specialist Mindful Health is a fast-growing company with the goal of providing an intentionally different approach to mental health and well-being. We are a combination of bricks ...

Midland Health

Nurse Utilization Review

Midland, TX

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... health care coverage. SHIFT AND SCHEDULE Full Time, Monday - Friday; 8:00 AM - 5:00 PM ESSENTIAL ...

Midland Health

Nurse Utilization Review

Midland, TX · On-site

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... health care coverage. SHIFT AND SCHEDULE Full Time, Monday - Friday; 8:00 AM - 5:00 PM ESSENTIAL ...

Midland Health

Nurse Utilization Review

Midland, TX

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... health care coverage. SHIFT AND SCHEDULE Full Time, Monday - Friday; 8:00 AM - 5:00 PM ESSENTIAL ...

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Full Time Optum Health Utilization Review information

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How much do full time optum health utilization review jobs pay per hour?

As of Jun 14, 2026, the average hourly pay for full time optum health 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 Full Time Optum Health Utilization Review vs Full Time Medical Coder?

AspectFull Time Optum Health Utilization ReviewFull Time Medical Coder
CertificationsUtilization Review Certification, CPC or RHIT often preferredCertified Coding Specialist (CCS), CPC
Work EnvironmentHealthcare facilities, insurance companies, remote optionsHospitals, clinics, remote coding roles
Job FocusReviewing medical necessity, authorizations, and insurance claimsTranslating medical records into standardized codes
Industry UsageCommon in health insurance and managed careWidely used in healthcare billing and documentation

While both roles are integral to healthcare operations, Full Time Optum Health Utilization Review focuses on assessing the necessity of care and insurance approvals, whereas Full Time Medical Coder specializes in accurately coding medical records for billing. Understanding these differences helps job seekers identify the right career path in healthcare administration and coding fields.

More about Full Time Optum Health Utilization Review jobs
What cities are hiring for Full Time Optum Health Utilization Review jobs? Cities with the most Full Time Optum Health Utilization Review job openings:
What are the most commonly searched types of Optum Health Utilization Review jobs? The most popular types of Optum Health Utilization Review jobs are:
What states have the most Full Time Optum Health Utilization Review jobs? States with the most job openings for Full Time Optum Health Utilization Review jobs include:
What job categories do people searching Full Time Optum Health Utilization Review jobs look for? The top searched job categories for Full Time Optum Health Utilization Review jobs are:
Full Time Optum Health Utilization Review jobs near you
Infographic showing various Full Time Optum Health Utilization Review job openings in the United States as of June 2026, with employment types broken down into 1% As Needed, 13% Full Time, 78% Part Time, and 8% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review Specialist

Utilization Review Specialist

Northlake Behavioral Health System

Mandeville, LA

Full-time

Posted 3 days ago

Job description

Position: Utilization Review Specialist

Status: Full Time, Days

Schedule: Mon-Fri, Days. New hire will have the option to choose a schedule of either 7:30am to 4:00pm or 8:00am to 4:30pm.
Are you experienced in navigating medical insurance authorizations? We're looking for a Utilization Review Specialist to ensure our inpatient psychiatric patients receive timely access to the care they need — and that our facility is appropriately reimbursed for the services we provide.

In this role, you'll conduct admission, concurrent, and continued stay reviews with managed care organizations, commercial insurers, and government payers. You'll work closely with psychiatrists, nurses, therapists, and case managers to make sure clinical documentation supports medical necessity, and you'll manage denials and appeals to protect both patient access and reimbursement.

What You'll Do

Utilization Review & Authorizations

  • Conduct admission, concurrent, and continued stay reviews for inpatient behavioral health patients

  • Evaluate patient records against payer medical necessity and level-of-care criteria

  • Complete telephonic and electronic reviews with managed care organizations and third-party payers

  • Secure initial and continued stay authorizations; track authorization periods and obtain extensions

  • Submit clinical information on time to prevent authorization lapses and reimbursement delays

Denials & Appeals

  • Review denials and coordinate reconsiderations, peer-to-peer reviews, and appeals

  • Prepare appeal packets with supporting clinical documentation

  • Monitor denial trends and identify ways to improve authorization outcomes

Clinical Documentation & Team Collaboration

  • Review psychiatric, nursing, and therapy documentation for accuracy and medical necessity support

  • Coach providers and clinical staff on documentation improvements

  • Participate in treatment team discussions to support medical necessity and discharge planning

  • Serve as the go-to resource on behavioral health payer criteria and UR processes

Data & Compliance

  • Maintain authorization, denial, and appeal tracking logs with timely, accurate data entry

  • Assist with audits, reporting, and performance improvement initiatives

  • Maintain compliance with federal/state regulations, accreditation standards, and HIPAA

What We're Looking For

Required:

  • Associate's degree in healthcare related field — OR a high school diploma/GED with at least 4 years of psychiatric, behavioral health, utilization review, case management, admissions, or related healthcare experience

  • Min 2 years of experience in a psychiatric, behavioral health, or healthcare setting

  • Knowledge of managed care, medical necessity criteria, utilization review, third-party reimbursement, and clinical documentation review

  • Strong organization and time management — you'll juggle multiple payer reviews and deadlines

Ready to apply? Submit your resume today

Northlake Behavioral Health is an equal opportunity/affirmative action employer. All qualified applicants are encouraged to apply and will receive consideration for all employment; free from discrimination based on race, creed, color, national origin, age, sex, pregnancy, sexual orientation, gender identity, genetic information, religion, associational preferences, status as a qualified individual with a disability, or status as a protected veteran.