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Optum Health Utilization Review Jobs (NOW HIRING)

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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 Jul 13, 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:
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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 July 2026, with employment types broken down into 1% As Needed, 76% Full Time, 18% Part Time, and 5% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review Specialist

Utilization Review Specialist

Sharon Regional Health System

Sharon, PA • On-site

Full-time

Re-posted 4 days ago

Job description

Job Summary
We are seeking a Utilization Review Specialist to join our healthcare team. The Utilization Review Specialist ensures that the appropriate authorization for treatment is secured, and that all pertinent clinical information is present to obtain this authorization. The UR Specialist works with the medical staff and the other members of the interdisciplinary team to assist in the delivery of quality care across the continuum. Planning for individual age-specific needs will occur as it relates to the assigned patient population. Documentation requirements are monitored by the UR Specialist.
Responsibilities
  • Secures authorization for payment of services rendered from all types of primary
  • and secondary insurers.
  • Maintains knowledge of coding and diagnostic standards to ensure appropriate
    service utilization.
  • Ensures the thoroughness of all documentation entered into the medical record.
  • Additional duties to be discussed.
Benefits
  • Valid Registered Nurse (RN) license in the state of practice.
  • Bachelor's degree preferred.
  • Minimum of 2 years' experience.
  • Familiarity with HIPAA regulations and patient confidentiality protocols.
  • Excellent communication skills, both verbal and written.
  • Demonstrated leadership and organizational skills.

Join our team of healthcare professionals dedicated to making a difference in the lives of
our patients!

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