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Optum Clinical Review Jobs (NOW HIRING)

UnitedHealth Group

IBR Clinical Review RN

Plymouth, MN · On-site

Optum is a global organization that delivers care, aided by technology, to help millions of people ... The Clinical Review Clinician serves as a subject matter expert for itemized bill reviews and ...

UnitedHealth Group

IBR Clinical Review RN

Plymouth, MN · Remote

Optum is a global organization that delivers care, aided by technology, to help millions of people ... The Clinical Review Clinician serves as a subject matter expert for itemized bill reviews and ...

UnitedHealth Group

Clinical Claim Review RN

Plymouth, MN · Remote

$29 - $52/hr

Optum is a global organization that delivers care, aided by technology, to help millions of people ... The clinical reviewer is responsible for documenting, researching state and federal guidelines and ...

UnitedHealth Group

Clinical Claim Review RN

Plymouth, MN · On-site

$29 - $52/hr

Optum is a global organization that delivers care, aided by technology, to help millions of people ... The clinical reviewer is responsible for documenting, researching state and federal guidelines and ...

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Optum Clinical Review information

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$14

$34

$90

How much do optum clinical review jobs pay per hour?

As of Jun 17, 2026, the average hourly pay for optum clinical review in the United States is $34.62, according to ZipRecruiter salary data. Most workers in this role earn between $16.59 and $32.93 per hour, depending on experience, location, and employer.

What is an Optum Clinical Review job?

An Optum Clinical Review job involves evaluating medical records and clinical information to ensure healthcare services meet necessary guidelines and policies. Clinical reviewers assess prior authorization requests, medical necessity, and adherence to regulatory standards. They work with healthcare providers, insurance plans, and internal teams to support accurate and efficient patient care decisions. Typically, these roles require medical or nursing expertise, such as an RN, LPN, or other healthcare professional background. The goal is to balance quality patient care while managing cost-effectiveness and compliance.

Does Optum pay well?

Optum Clinical Review positions typically offer competitive salaries within the healthcare industry, with pay rates varying based on experience, location, and specific role responsibilities. Employees often report that compensation is aligned with industry standards for healthcare review and clinical roles, and benefits may include health insurance and professional development opportunities.

What types of cases or reviews does an Optum Clinical Review professional typically handle?

As an Optum Clinical Review professional, you'll primarily assess requests for medical services, procedures, and hospitalizations to determine medical necessity, appropriateness, and compliance with coverage guidelines. This includes reviewing prior authorizations, concurrent and retrospective reviews, and appeals for a variety of specialties and settings. The role requires a thorough understanding of clinical documentation and payer policies, and often involves collaboration with physicians, case managers, and other healthcare team members. While the majority of work may be desk-based, your clinical judgment plays a key role in ensuring patients receive evidence-based care within established benefit limits.

What jobs pay $10,000 a month without a degree?

High-paying jobs that can reach $10,000 a month without a degree include roles such as sales managers, real estate brokers, commercial pilots, and certain skilled trades like electricians or plumbers with experience. These positions often require specialized skills, certifications, or extensive experience, and income can vary based on performance and location.

What jobs pay 2000 a day?

Jobs that can pay $2,000 a day typically include high-level consulting, specialized medical professionals such as surgeons or anesthesiologists, and certain executive roles. These positions often require advanced skills, certifications, or extensive experience, and may involve freelance or contract work with high hourly rates or project-based payments.

What is an Optum clinical review?

An Optum clinical review is a process where healthcare professionals evaluate medical records, treatment plans, and patient information to determine appropriate care, coverage, or reimbursement. This role requires strong knowledge of medical guidelines, attention to detail, and often involves using electronic health record systems. It is essential for ensuring compliance with healthcare policies and optimizing patient outcomes.

What are the key skills and qualifications needed to thrive in the Optum Clinical Review position, and why are they important?

To thrive as an Optum Clinical Review professional, you need a strong clinical background, an active RN or other clinical license, and experience in medical assessment and utilization management. Familiarity with health insurance platforms, medical coding systems (like ICD-10 and CPT), and electronic medical records is typically required. Excellent attention to detail, strong analytical thinking, and effective communication with both clinicians and non-clinical staff are valued soft skills. These competencies ensure review accuracy and compliance, support quality patient outcomes, and improve collaboration within a fast-paced healthcare environment.

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What cities are hiring for Optum Clinical Review jobs? Cities with the most Optum Clinical Review job openings:
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Optum Clinical Review jobs near you
Infographic showing various Optum Clinical Review job openings in the United States as of June 2026, with employment types broken down into 100% Full Time. Highlights an 83% In-person, and 17% Remote job distribution, with an average salary of $72,002 per year, or $34.6 per hour.
IBR Clinical Review RN

IBR Clinical Review RN

UnitedHealth Group

Plymouth, MN • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 23 days ago

UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 141 frontline employees who took The Breakroom Quiz

187th of 872 rated healthcare providers

Job description

Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale.Join us to start Caring. Connecting. Growing together.
The Clinical Review Clinician serves as a subject matter expert for itemized bill reviews and analyzing hospital facility bills. The clinical reviewer is responsible for documenting, researching and identifying adjustments for payment as part of a team that contributes to the preparation of Forensic Reviews for specific clients.
Employees in this position receive limited supervision within a broad framework of policies and procedures. Employees in this position possess a comprehensive understanding of the claim review process including clinical claim review, medical record review, and a broad knowledge of applicable processes, procedures and billing guidelines.
You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Claim Review:
  • Conduct Forensic Reviews using independent clinical knowledge to compare and analyze charge details of various amounts of total billed charges to determine benefit of full clinical review and estimation of adjustments for the purpose of meeting Optum's core business operations
  • Complete analysis of billing and departmental guidelines
  • Participate as needed in the achievement and completion of department goals
  • Complete focused review of medical records to evaluate clinical course of care as applicable
  • Assists with resolution of claims as needed to support negotiations and appeals process
  • Interacts with internal business partners as requested
  • Maintains appropriate documentation on all claims according to departmental guidelines and procedures
  • Understand and maintain HIPAA confidentiality and privacy standards when completing assigned work

Other: Research and Special Projects:
  • Perform research to support audit adjustments and resolve issues
  • Research reference materials for clinical standards as appropriate
  • Perform research to identify new adjustments and business rules for the goal of meeting core business operations
  • Review and respond to research inquiries from team members and complete special research projects
  • Participate in department and company meetings as requested

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
  • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
  • Medical Plan options along with participation in a Health Spending Account or a Health Saving account
  • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
  • 401(k) Savings Plan, Employee Stock Purchase Plan
  • Education Reimbursement
  • Employee Discounts
  • Employee Assistance Program
  • Employee Referral Bonus Program
  • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
  • Associate's degree (or higher)
  • Active and unrestricted RN license OR LPN in the state of residence
  • 2+ years of clinical experience within an acute care setting
  • 1+ years of experience working with bill review

Preferred Qualifications:
  • Auditing and coding certifications
  • Experience working with medical terminology and coding
  • Experience working with billing, charge master and compliance
  • Experience working with plan benefit language, CMS (Medicaid and Medicare) and UB 04 billing guidelines
  • Experience with Microsoft Excel (create, data entry, save)
  • Strong written and verbal communication skills
  • Strong organizational and critical thinking skills

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.94 to $51.83 per hour based on full-time employment. We comply with all minimum wage laws as applicable .
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
#RPO #GREEN

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