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Optum Health Utilization Review Jobs (NOW HIRING)

Midland Health

Nurse Utilization Review

Midland, TX · On-site

The utilization review examines how health care services are being utilized. The UR nurse requires extensive knowledge of patient care, medical treatments and hospital procedures. The UR nurse will ...

Midland Health

Nurse Utilization Review

Midland, TX

The utilization review examines how health care services are being utilized. The UR nurse requires extensive knowledge of patient care, medical treatments and hospital procedures. The UR nurse will ...

Midland Health

Nurse Utilization Review

Midland, TX · On-site

The utilization review examines how health care services are being utilized. The UR nurse requires extensive knowledge of patient care, medical treatments and hospital procedures. The UR nurse will ...

Midland Health

Nurse Utilization Review

Midland, TX

The utilization review examines how health care services are being utilized. The UR nurse requires extensive knowledge of patient care, medical treatments and hospital procedures. The UR nurse will ...

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL · On-site

$55K - $70K/yr

Best in Business, Health Services. About the Role As a Utilization Review Specialist, you will play a pivotal role in ensuring the efficient and effective utilization of healthcare resources. The UR ...

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL · On-site

$55K - $70K/yr

Best in Business, Health Services. About the Role As a Utilization Review Specialist, you will play a pivotal role in ensuring the efficient and effective utilization of healthcare resources. The UR ...

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

As of Jun 8, 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.

More about Optum Health Utilization Review jobs
What cities are hiring for Optum Health Utilization Review jobs? Cities with the most Optum Health Utilization Review job openings:
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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 May 2026, with employment types broken down into 3% Internship, 1% As Needed, 77% Full Time, 10% Part Time, 7% Temporary, and 2% Nights. Highlights an 90% Physical, 1% Hybrid, and 9% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review Specialist

Utilization Review Specialist

PRAESUM HEALTHCARE

West Palm Beach, FL • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 3 days ago

Job description

Praesum Healthcare:
Position Title: Utilization Review Specialist
Founded in 2003, Praesum Healthcare provides administrative services for healthcare providers in key geographical locations throughout the Northeast, mid-Atlantic, and Southeast regions. Praesum is an established leader in the healthcare industry. With a solid, growth-focused business model, strong finances, and expert management team, Praesum will continue to grow in the years to come. Praesum currently provides services to behavioral health facilities providing all levels of care from inpatient psychiatric and substance abuse detoxification, through SUD and mental health outpatient clinics.
Utilization Review Specialist Job description:
Perform duties to authorize and review utilization of mental health and substance abuse services provided in inpatient, outpatient and intermediate care settings.
Utilization Review Specialist Duties/Responsibilities:
• Initiate pre-certification and continued stay authorizations based on ASAM criteria
• Communicate directly with facility regarding patients' needs and symptomology
• Maintain daily census scheduling all new admissions and concurrent reviews
• Input of authorizations and appropriate demographic information to EHR for billing purposes
• Completing "peer to peer" reviews and scheduling "Doctor to Doctor" reviews when needed
• Confirm insurance coverage of each patient
• Organize weekend census of all detox and residential patients for all our impatient facilities
• Collect all appropriate clinical data for each patient that requires precertification
Utilization Review Specialist Requirements:
• High School Diploma
• A minimum of 3-5 years of utilization review experience.
• Individual must be computer literate with proficiency in Microsoft Office applications.
Utilization Review Specialist Schedule:
• Full Time, Friday - Monday (weekends) with potential for bonus
• 8:30am to 05:00pm
Utilization Review Specialist Compensation:
• Hourly rate competitive with experience and location
Full time employees may be eligible for the following:
• Insurance: Medical, Dental, Vision, and STD options
• Medical FSA and Dependent Care Account
• 401k with company match up to 5%
• Accrued Paid Time Off (PTO)
• Education reimbursement
• Career Advancement Opportunities
*** This job does NOT sponsor visa's and we are unable to consider out of country applicants ***
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