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Optum Health Utilization Review Jobs (NOW HIRING)

Southeast Health

Utilization Review Nurse

Dothan, AL · On-site

The Utilization Review case manager collaborates with all components of the healthcare system, managing appropriate use of acute care to aid in the achievement of quality outcomes, fiscal ...

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 ...

Genesis HealthCare

GENESIS HEALTHCARE SYSTEM In order to fill our Mission of serving our community by helping each ... The Utilization Review (UR) Analyst is responsible for assuring insurance notification ...

Banyan

Utilization Review Specialist

Pompano Beach, FL · On-site

High School diploma or equivalent; graduate degree in a health or behavioral health related field preferred. * Minimum of one-year experience working in a utilization review position (psychiatric or ...

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

As of Jun 9, 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 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 Coordinator

Utilization Review Coordinator

Oceans Healthcare

Norman, OK • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 26 days ago

Oceans Healthcare rating

4.7

Company rating: 4.7 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

Job description

Description
Full-time Utilization Review Coordinator
  • Associate's Degree with emphasis on healthcare or Bachelor's degree in social services field preferred.
  • At least one year psychiatric/chemical dependency experience with good working psychiatric/medical knowledge.
  • Utilization review experience REQUIRED

The Utilization Review Coordinator is responsible for management of all utilization review activities for the facility's inpatient, partial hospitalization, and outpatient programs. Conducts concurrent reviews of all medical records to ensure criteria for admission and continued stay are met and documented, and to ensure timely discharge planning. Coordinates information between third party payers and medical/clinical staff members. Interacts with members of the medical/clinical team to provide a flow of communication and a medical record which documents and supports level and intensity of service rendered. All duties to be done in accordance with Joint Commission, Federal and State regulations, Oceans' Mission, policies and procedures and Performance Improvement Standards.
Benefits We Offer:
Medical, Dental, Vision Coverage (Multiple Plan Options) - Eligible first of the month after 30 days.
401 (k) Retirement Savings Plan with Discretionary Company Match
Tuition Reimbursement
Daily Pay
Paid Time Off
Competitive Market Compensation
Short Term Disability, Long Term Disability
Life Insurance
Employee Assistance Program
Essential Functions:
  1. Identifies and reports appropriate use, under-use, over-use and inefficient use of services and resources to ensure high quality patient care is provided in the least restrictive environment and in a cost-effective manner.
  2. Conducts review of all inpatient, partial hospitalization, and outpatient records as outlined in the Utilization Review/Case Management plan to (1) determine appropriateness and clinical necessity of admissions, continued stay, and or rehabilitation, and discharge; (2) determine timeliness of assessments and evaluations; i.e. H&Ps, psychiatric evaluation, CIA formulation, and discharge summaries; and (3) identify any under-, over-, and/or inefficient use of services or resources.
  3. Reports findings to appropriate disciplines and/or committees; notifies appropriate staff members of any deficiencies noted so corrective actions can be taken in a timely manner; submits monthly report to PI Coordinator of findings and actions recommended to correct identified problems.
  4. Coordinates flow of communication between physicians/staff and third party payers concerning reimbursement requisites
  5. Attends mini-treatment team and morning status meetings each weekday to obtain third-party payer pre-certification and ongoing certification requirements and to share with those attending any pertinent data from third-party payer contracts.
  6. Attends weekly treatment team.
  7. Conducts telephone reviews to, and follows through with documentation requests from third party payers.
  8. Maintains abstract with updates provided to third party payers.
  9. Notifies physicians/staff/patients of reimbursement issues.
  10. Initiates and completes appeals process for reimbursement denials; notifies inpatients of denials received.
  11. Reports monthly all Hospital Issued Notices of Non-coverage (HINN letter) to QIO.
  12. Conducts special retrospective studies/audits when need is determined by M&PS and /or other committee structure.
  13. Ensures all authorization and denied information is in HCS at the end of each business day.
  14. Performs other duties and projects as assigned.

Requirements
Educational / Experience Requirements:
  • Associate's Degree with emphasis on healthcare or Bachelor's degree in social services field preferred.
  • At least one year psychiatric/chemical dependency experience with good working psychiatric/medical knowledge.

Qualifications/Skills:
  • Must have excellent assertive communication skills.
  • Knowledge and in-depth understanding of CD-psych treatment and discharge planning process.
  • Must have good writing and composition skills.
  • Must have good understanding of regulatory and fiscal reimbursement and utilization review as a primary component of patient care.
  • Must demonstrate strong patient advocacy skills.
  • Must be able to organize and prioritize high volume workload.
  • Must be able to analyze and utilize data and systems to provide individualized quality treatment in a cost-effective manner.
  • Must be able to function with minimal supervision.
  • Therapeutic Intervention De-escalation Education required.
  • Must have ability to maintain overall good work attitude and interact cooperatively and professionally with other staff members and third party payers to achieve mutually beneficial outcome.
  • Must possess basic competency in age, disability, and cultural diversity for needs of patients served and ability to relate to patients in a manner sensitive to those needs.
  • Must successfully complete CPR certification and an Oceans approved behavioral health de-escalation program.

Work Environment:
Subject to many interruptions. Occasional pressure due to multiple calls and inquiries. This position can be high paced and stressful; must be able to cope mentally and physically to atmosphere. Work requires spending approximately 90% or more of the time inside a building that offers protection from weather conditions but not necessarily from temperature changes.

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