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Optum Health Utilization Review Jobs in Texas (NOW HIRING)

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

... Health Care Insurance Company. * Knowledge of medical terminology and procedures. * Verbal and ... Utilization management experience LOCATION: REMOTE in Texas ( Richardson area ? Dallas/Collin ...

Medix

Utilization Review Nurse

Fort Worth, TX · On-site

$38.46 - $43.27/hr

Job Summary Our client is seeking a skilled Utilization Review Nurse to join their team. This role ... Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 ...

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Optum Health Utilization Review information

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.

What are the most commonly searched types of Optum Health Utilization Review jobs in Texas?

The most popular types of Optum Health Utilization Review jobs in Texas are:

What are popular job titles related to Optum Health Utilization Review jobs in Texas?

For Optum Health Utilization Review jobs in Texas, the most frequently searched job titles are:

What job categories do people searching Optum Health Utilization Review jobs in Texas look for?

The top searched job categories for Optum Health Utilization Review jobs in Texas are:

What cities in Texas are hiring for Optum Health Utilization Review jobs?

Cities in Texas with the most Optum Health Utilization Review job openings:

Optum Health Utilization Review jobs near you
Infographic showing various Optum Health Utilization Review job openings in Texas as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution.

Utilization Review Assistant

Medical Center Hospital

Odessa, TX • On-site

Part-time

Re-posted 20 days ago

Medical Center Health System rating

8.4

Company rating: 8.4 out of 10

Based on 34 frontline employees who took The Breakroom Quiz

22nd of 898 rated healthcare providers

Job description

Position Summary:
Assists UM Department with utilization review processes, including the collection and analysis of various computer-based data related to Utilization Review, Care Coordination, and Commercial Insurance.

Qualifications:
A. Education:
Must have a high school diploma or equivalent.
B. Training and Experience:
Must have a minimum of one-year work experience in an acute care medical facility.
C. Job Knowledge:
Familiar with medical terminology, utilization review, community resource a plus. Basic computer skills required. Be able to communicate effectively verbally and in writing.

Unusual Physical Demands and Working Conditions:
Should be familiar with healthcare operations. Experience with the collection and management of data preferred. Familiar with medical terminology, utilization review, and/or medical insurance preferred.
Ability to communicate effectively and professionally, both verbally and in writing.

What Medical Center Health System employees say

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