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

As of Aug 24, 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 is an Optum Health Utilization Review?

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?

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.

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.

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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 August 2026, with employment types broken down into 2% As Needed, 76% Full Time, 16% Part Time, and 6% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Supervisor Behavioral Health Utilization Review

Saint Luke's Hospital of Kansas City

Kansas City, MO • On-site

Full-time

Re-posted 5 days ago

Saint Luke's Health System (Kansas City) rating

7.1

Company rating: 7.1 out of 10

Based on 110 frontline employees who took The Breakroom Quiz

382nd of 893 rated healthcare providers

Job description

Job Description

Saint Luke's Crittenton Children's Center in South Kansas City, MO is seeking a Supervisor of Behavioral Health Utilization Review to join our team.

This role facilitates and directs the Utilization Review Department, Case Management and Reception teams of a 24/7 inpatient residential and hospital program. Additionally, ensures compliance with all pertinent regulations, analyzes trends related to denials & authorizations, builds strong relationships with third party payers. Positive relationships with physicians, nursing supervisors and senior administration are required to ensure empathic and timely response to individual patient and community needs.

Job Details:

  • Monday - Friday, dayshift, 9am -5pm. Remote work not preferred, but occasional opportunity, must be primarily onsite. No weekend or holiday rotations.
  • Supervises and completes daily operations as assigned by Manager of Intake and Utilizations Review.
  • Oversees resources and functions related to utilization review and regulatory compliance adherence.
  • Responsible for training of staff, discipline and evaluations.
  • Monitors and maintains data to achieve quality outcomes and progression with the departmental strategic plan.
  • Collaborates and communicates with the multidisciplinary team to ensure communication of patient's treatment to the managed care provider.
  • Review clinical charts in order to file appeals on denied accounts.
  • Oversees scheduling and supervision needs for the Reception team.
  • Must have a master's degree and current clinical licensure for State of Missouri (LPC or LCSW)
  • 1-3 years in a leadership or team lead role preferred
Job Requirements

Applicable Experience:

2 yearsLicensed Professional Counselor - VariousMaster's DegreeJob DetailsFull TimeDay (United States of America)

The best place to get care. The best place to give care. Saint Luke's 12,000 employees strive toward that vision every day. Our employees are proud to work for the only faith-based, nonprofit, locally owned health system in Kansas City. Joining Saint Luke's means joining a team of exceptional professionals who strive for excellence in patient care. Do the best work of your career within a highly diverse and inclusive workspace where all voices matter.

Join the Kansas City region's premiere provider of health services. Equal Opportunity Employer.

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