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Full Time Optum Utilization Review Jobs (NOW HIRING)

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 · 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

Director of Utilization Review

Blue Springs, MO · On-site

Oversee precertification, concurrent, and discharge utilization reviews. * Facility regulatory ... Full-time Benefits Include: * Competitive Compensation and Generous Paid Time Off * Excellent ...

UK St Claire

Utilization Review Nurse

Morehead, KY · On-site +1

Supports utilization review processes by planning, analyzing data, and setting goals to ensure ... Days (United States of America) Time Type: Full time Address : 222 Medical Circle City, State

UHS

Director of Utilization Review

Blue Springs, MO

Oversee precertification, concurrent, and discharge utilization reviews. * Facility regulatory ... Full-time Benefits Include: * Competitive Compensation and Generous Paid Time Off * Excellent ...

UHS

Director of Utilization Review

Blue Springs, MO · On-site

Oversee precertification, concurrent, and discharge utilization reviews. * Facility regulatory ... Full-time Benefits Include: * Competitive Compensation and Generous Paid Time Off * Excellent ...

Ascension

Registered Nurse Utilization Review

Austin, TX · Remote

$84K - $118K/yr

Days l Full Time Salary range: $84,060.91 - $118,668.99per year (Texas) | Pay ranges vary based on ... May prepare statistical analysis and utilization review reports as necessary. * Oversee and ...

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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 Technician III

Utilization Review Technician III

Prime Healthcare

Ontario, CA • On-site, Remote

$23.15 - $30.03/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 22 days ago

Prime Healthcare rating

6.3

Company rating: 6.3 out of 10

Based on 269 frontline employees who took The Breakroom Quiz

663rd of 870 rated healthcare providers

Job description

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!
 


The Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. This position will also serve as a liaison and own the coordination with other UR techs in the team while being responsible for coordinating phone calls, data entry, mailing/faxing appeals and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals. Document and track all communication attempts with insurance providers and health plans and scan all related correspondence to the respective EMR/ tracking tool. Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers. The Utilization review tech will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned. UR tech III will also function as an SME to support the UR tech team and remote counter parts with the specific processes as applicable. The Utilization review tech will further support the department needs for Release of Information through faxing and mailing, discharge coordination or other duties as assigned.


  1. Bachelor’s degree or four years of relevant experience required.
  2. Microsoft office proficiency.
  3. Good communication skills

Preferred qualifications:

  1. Completion of a medical terminology course; preferred.
  2. Knowledge of HIPAA regulations preferred.

Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $23.15 to $30.03. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.


Full Time
Days

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

 

Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf

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