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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 ...

HHC

UTILIZATION REVIEW SPECIALIST

Indianapolis, IN · On-site

Eskenazi Health serves as the public hospital division of the Health & Hospital Corporation of ... Optum, VA, and other payor platforms. Ability to provide direct support to providers regarding ...

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

As of Jun 14, 2026, the average hourly pay for 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 are some common challenges faced by Optum Health Utilization Review specialists and how does the team address them?

Optum Health Utilization Review specialists often encounter challenges such as staying current with frequently changing healthcare regulations, handling complex medical cases, and managing high caseloads with tight deadlines. The team fosters a collaborative environment where members can consult with medical directors, other clinical reviewers, and support staff to resolve difficult cases and clarify policies. Regular training sessions, ongoing education, and access to up-to-date resources help team members stay informed and manage these challenges effectively. This supportive structure enables specialists to maintain high accuracy and efficiency while delivering quality outcomes for patients and providers.

What is an Optum Health Utilization Review job?

An Optum Health Utilization Review job involves assessing medical necessity, appropriateness, and efficiency of healthcare services. Professionals in this role review patient records, insurance claims, and treatment plans to ensure compliance with industry standards and policies. They collaborate with healthcare providers, insurance companies, and patients to optimize care while managing costs. The position requires strong clinical knowledge, attention to detail, and familiarity with medical guidelines. It plays a crucial role in improving healthcare quality and reducing unnecessary expenses.

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

To excel in an Optum Health Utilization Review role, you typically need a background in nursing or a related clinical field, a valid RN license, and familiarity with healthcare policies and guidelines. Experience with utilization management software, electronic medical records (EMR) systems, and potentially certifications such as CCM (Certified Case Manager) are highly valued. Strong analytical skills, attention to detail, and effective communication are important soft skills for evaluating medical necessity and collaborating with providers. These competencies ensure accurate, compliant review processes that support optimal patient care and organizational efficiency.

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What cities are hiring for Optum Health Utilization Review jobs? Cities with the most 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:
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Optum Health Utilization Review jobs near you
Infographic showing various Optum Health Utilization Review job openings in the United States as of June 2026, with employment types broken down into 20% As Needed, 40% Full Time, and 40% Part Time. 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.