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Full Time Optum Utilization Review Jobs (NOW HIRING)

UHS

Utilization Review Coordinator

Scottsdale, AZ · On-site

Responsibilities Utilization Review Coordinator Full Time Via Linda Behavioral Hospital is a behavioral health provider serving Scottsdale and the greater Phoenix area. We opened in February 2022 and ...

UHS

Utilization Review Coordinator

Scottsdale, AZ

Full-time Employee Benefits include: * * Challenging and rewarding work environment * Competitive Compensation & Generous Paid Time Off * Excellent Medical, Dental, Vision and Prescription Drug Plans

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At Umpqua Health, we're more than a health ... utilization review or case management experience in managed care * Oregon residency and license

UHS

Utilization Review Coordinator

Champaign, IL · On-site

Responsibilities Full-time Utilization Review Coordinator Opening The Pavilion Behavioral Health System has been the leading provider of behavioral health and addictions treatment for families in ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At Umpqua Health, we're more than a health ... utilization review or case management experience in managed care * Oregon residency and license

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Full Time Optum Utilization Review information

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

As of Jun 9, 2026, the average hourly pay for full time 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 Full Time Optum Utilization Review nurses, and how can they be managed?

Full Time Optum Utilization Review nurses often encounter challenges such as managing high caseloads, staying updated with frequently changing insurance and regulatory guidelines, and effectively communicating with both healthcare providers and patients. Time management and strong organizational skills are crucial for balancing documentation with timely case reviews. Collaborating closely with multidisciplinary teams and utilizing technology tools provided by Optum can help streamline workflows and ensure compliance with policies, ultimately leading to more effective patient care coordination.

What are the key skills and qualifications needed to thrive as a Full Time Optum Utilization Review Nurse, and why are they important?

To thrive as a Full Time Optum Utilization Review Nurse, you need a current RN license, strong clinical assessment skills, and a solid understanding of medical necessity criteria and healthcare regulations. Familiarity with utilization management software, electronic health records (EHRs), and platforms like InterQual or MCG is typically required. Excellent communication, critical thinking, and attention to detail are vital soft skills for effectively coordinating care and collaborating with providers. These abilities ensure efficient, compliant care management, cost containment, and optimal patient outcomes within the healthcare system.

What is a Full Time Optum Utilization Review position?

A Full Time Optum Utilization Review position involves working for Optum, a healthcare services company, to review patient medical records and determine the medical necessity and appropriateness of healthcare services. Utilization Review professionals collaborate with healthcare providers, insurers, and patients to ensure that care provided is efficient, cost-effective, and aligns with established guidelines. The role typically requires knowledge of clinical standards, strong communication skills, and the ability to interpret medical documentation. Full-time positions often come with benefits and require standard weekly work hours.

What is the difference between Full Time Optum Utilization Review vs Full Time Medical Reviewer?

AspectFull Time Optum Utilization ReviewFull Time Medical Reviewer
CertificationsTypically requires medical licenses and utilization review certificationsRequires medical licenses, often with additional certifications in utilization review
Work EnvironmentInsurance companies, healthcare organizations, remote or office-basedHospitals, clinics, insurance companies, often in clinical settings
Employer & Industry UsagePrimarily in health insurance and managed careIn healthcare facilities and insurance sectors

Full Time Optum Utilization Review professionals focus on evaluating medical necessity for insurance claims, often working remotely or in insurance settings. Full Time Medical Reviewers also assess medical necessity but may work directly within clinical environments. Both roles require medical credentials and involve reviewing patient records, but their work settings and employer types differ slightly.

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

Utilization Review Nurse

Rising Medical Solutions

Chicago, IL • On-site, Remote

Full-time

Medical, Dental, Vision, Retirement

Posted 7 days ago

Job description

Rising Medical Solutions has an opening for a Utilization Review Nurse, and we want to hear from you! We're a bill review and cost containment company - so what does that mean? Basically we are trying to fix a very broken healthcare system by reducing the cost of healthcare claims through bill review, case management, and utilization review. Our mission is "To make lives better" and everyone here at Rising works hard to achieve this goal. So take a look at the job, let us know what you think, and let's start working towards a better future!
**This is a full-time position - 40 hours per week (Must work M-F each day).
Responsibilities
  • Perform all aspects of the Utilization Review Process
  • Review records and requests for UR, which may arrive via mail, e-mail, fax, or phone
  • Utilize evidence-based guidelines to determine if authorization can be given versus having to send the file or for Peer or Physician Review
  • Write nurse summaries on all UR files
  • Document properly in Rising's database (and client data bases when appropriate), and send determination letters on each completed UR
  • Establish collaborative relationships with clients, patients, employers, providers and attorneys
  • Track ongoing status of all UR activity so that appropriate turn-around times are met
  • Maintain organized files containing clinical documentation of interactions with all parties of every claim
  • Utilize good clinical judgment, careful listening, and critical thinking and assessment skills
  • Respond to various written and telephonic inquiries regarding status of case
  • Must be proficient in the use of a computer, including the use of various software programs simultaneously

Requirements
  • An Associate's or Bachelor's degree in Nursing
  • Hold an active and unencumbered RN license in one or more states
  • 3 to 5 years of clinical practice experience or 2 years of case management and/or UR experience
  • More than one state license (a plus)
  • Experience with Workers' Compensation, short-term or long-term disability, or liability claims
  • The ability to set priorities and work both autonomously and as a team member
  • Well-developed time-management, organization, and prioritization skills
  • Excellent analytical skills
  • Superb oral and written communication
  • The ability to gather data, compile information, and prepare summary reports
  • Strong interpersonal and conflict resolution skills
  • Experience in a fast-paced, multi-faceted environment
  • Demonstrated persistence and attention to detail
  • General understanding of CPT and ICD-9/ICD-10 codes and Medicare guidelines
  • Working knowledge of: Microsoft Word, Excel, and Outlook
  • Ability to remain calm during stressful situations
  • A customer-service mindset

Benefits
    • Generous Flexible Time Off (take it when you need it!)
    • Comprehensive benefit package including health/dental/vision insurance, profit sharing, and 401k matching
    • Career Growth Opportunities - We often promote from within
    • Professional Development Reimbursement Program (PDRP)
    • You will be part of our new Elevate program designed to recognize and reward employees for their hard work
    • Rising was named a Top Workplace in the healthcare industry for 2023! Check out our profile here: Working at Rising Medical Solutions Top Workplaces
    • We're on YouTube! Check out our culture at: http://www.youtube.com/user/RisingMedical
    • Want to see more? Check out our:
      • Facebook: https://www.facebook.com/RisingMedicalSolutions
      • LinkedIn: http://www.linkedin.com/company/rising-medical-sol..

If you are ready to join a team of professionals dedicated to making a difference and making lives better, please apply today!

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