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Optum Health Utilization Review Jobs (NOW HIRING)

Merrimack Health

Utilization Review Nurse

Lawrence, MA · On-site

... they relate to utilization review and discharge planning and payer regulations. MINIMUM EDUCATION AND EXPERIENCE: Required: * Graduate of an accredited professional nursing school * Current ...

Merrimack Health

Utilization Review Nurse

Methuen, MA · On-site

... they relate to utilization review and discharge planning and payer regulations. MINIMUM EDUCATION AND EXPERIENCE: Required: * Graduate of an accredited professional nursing school * Current ...

Acrisure, LLC

Collaborate with physicians, healthcare providers, claims professionals, and internal team members ... Utilization review or case management experience highly beneficial* Clinical experience involving ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure ... Collaborate with physicians, healthcare providers, claims professionals, and internal team members ...

Socket.dev

Utilization Review Specialist

Knoxville, TN · On-site

At Bradford Health Services, we are committed to providing exceptional care to our patients while ... The Utilization Review Specialist plays a critical role in ensuring that healthcare services ...

UHS

PR · On-site

The Utilization Review (UR) Director is responsible for overseeing the utilization management ... Supervise the review process to ensure that requests for mental health treatment are approved or ...

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

As of Sep 14, 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 September 2026, with employment types broken down into 77% Full Time, 15% Part Time, and 8% Contract. Highlights an 77% In-person, and 23% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Behavioral Health Utilization Management Specialist

Draper, UT • On-site, Remote

Row Partners
See more jobs at Row Partnersexternal

$60K - $70K/yr

Full-time

Medical, Dental, Vision, PTO

Re-posted yesterday

Key responsibilities

  • Review medical records and clinical documentation to determine medical necessity and appropriateness of behavioral health services.

  • Collaborate with clinicians, medical staff, and insurance providers to ensure patients receive timely access to services.

  • Conduct clinical reviews for inpatient, outpatient, and residential behavioral health services.

Job description

Behavioral Health Utilization Management Specialist 

Location: Utah (Hybrid & Remote Options Available) 

Job Type: Full-time 

Department: Behavioral Health / Utilization Management 

Who We Are 

At Row Partners, we’re more than a healthcare support organization — we’re a passionate team dedicated to empowering behavioral health facilities and their patients. We believe that compassionate, accessible, and high-quality care starts with the right people on our team. 

Our Behavioral Health division is growing, and we’re looking for a Behavioral Health Utilization Management Specialist who shares our commitment to improving access, ensuring appropriate care, and supporting patient success stories every day. 

If you’re driven by purpose, thrive in a collaborative environment, and want your work to make a real difference, this role is for you. 

The Role 

As a Behavioral Health Utilization Management Specialist, you will be the bridge between clinical care and insurance coverage — ensuring patients receive the right services, at the right time, for the right reasons. Your expertise will help providers, patients, and payers work together toward the shared goal of better behavioral health outcomes. 

What You’ll Do 

  • Champion patient care by reviewing medical records and clinical documentation to determine medical necessity and appropriateness of behavioral health services. 
  • Collaborate and connect with clinicians, medical staff, and insurance providers to make sure patients get timely access to the services they need.
  • Conduct clinical reviews for inpatient, outpatient, and residential behavioral health services.
  • Ensure quality of care by reviewing treatment plans, discharge plans, and progress toward goals.
  • Support evidence-based treatment by applying clinical criteria and guidelines to approve and recommend necessary care. 
  • Stay ahead of industry standards, insurance requirements, and treatment protocols. 
  • Advocate for patients by facilitating communication and resolving barriers between providers, patients, and payers. 
  • Document with precision for utilization reviews, audits, and compliance needs. 

What You Bring 

Proven Success 

  • A history of professional growth, creative problem-solving, and a commitment to excellence. 
  • Integrity, accountability, and a collaborative spirit that uplifts your team and patients alike. 

Preferred Experience 

  • 2+ years in utilization management, case management, or behavioral health services 
  • Familiarity with mental health and substance use disorder diagnoses. 
  • Understanding of insurance coding, billing, and behavioral health authorization procedures. 

Preferred Skills 

  • Strong knowledge of Behavioral Health diagnosis, Treatments, and evidence-based practices.
  • Comfort with utilization management tools (ASAM, MCG, InterQual). 
  • Excellent communication and relationship-building skills.
  • Ability to multitask in a fast-paced environment. 
  • EHR system proficiency. 

(If you don’t have all the experience listed, but have the passion and potential to succeed, we’re willing to train the right candidate.) 

Work Location 

  • Based in Sandy, Utah — remote work available for those living more than 50 miles from the office. 

Why You’ll Love Working With Us 

  • Competitive salary & comprehensive benefits (health, dental, vision).
  • Paid time off, sick leave, and paid holidays.
  • Opportunities for growth, training, and continuing education. 
  • Supportive, team-first culture where your contributions matter. 
  • The chance to impact lives and improve care outcomes every single day. 

If you’re ready to use your skills to make a lasting difference in behavioral health care, we’d love to hear from you. Apply today and join a team thats shaping the future of patient care.