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Optum Physician Utilization Management Jobs (NOW HIRING)

UHS

Director Utilization Management

Plymouth, IN · On-site

... a physician network and various related services located in 40 U.S. states, Washington, D.C ... utilization management for both mental health and substance abuse behavioral health disorders.

UHS

Director Utilization Management

Plymouth, IN · On-site

... a physician network and various related services located in 40 U.S. states, Washington, D.C ... utilization management for both mental health and substance abuse behavioral health disorders.

UHS

Director Utilization Management

Plymouth, IN · On-site

... a physician network and various related services located in 40 U.S. states, Washington, D.C ... utilization management for both mental health and substance abuse behavioral health disorders.

UHS

Director Utilization Management

Plymouth, IN · On-site

... a physician network and various related services located in 40 U.S. states, Washington, D.C ... utilization management for both mental health and substance abuse behavioral health disorders.

UHS

Director Utilization Management

Plymouth, IN · On-site

... a physician network and various related services located in 40 U.S. states, Washington, D.C ... utilization management for both mental health and substance abuse behavioral health disorders.

Toney Healthcare

Be Seen First

Physician Reviewer Utilization Management

Tampa, FL · Remote

$180 - $200/hr

The Physician Reviewer serves as a clinical subject matter expert in the Utilization Management (UM) department. This role is responsible for conducting clinical reviews of medical necessity ...

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Optum Physician Utilization Management information

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$39K

$89.5K

$163K

How much do optum physician utilization management jobs pay per year?

As of Sep 12, 2026, the average yearly pay for optum physician utilization management in the United States is $89,483.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,500.00 and $104,500.00 per year, depending on experience, location, and employer.

What are popular job titles related to Optum Physician Utilization Management jobs?

For Optum Physician Utilization Management jobs, the most frequently searched job titles are:

Infographic showing various Optum Physician Utilization Management job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 13% Part Time, and 2% Contract. Highlights an 83% Physical, 2% Hybrid, and 15% Remote job distribution, with an average salary of $89,483 per year, or $43 per hour.

RN - Utilization Management

Milford, NH • On-site

Central Business Solutions
See more jobs at Central Business Solutionsexternal

Other

Re-posted 13 days ago

Job description

Utilization Management Registered Nurse (UM RN)

We are seeking an experienced and detail-oriented Utilization Management Registered Nurse (UM RN) to join our hospital team. The UM RN is responsible for reviewing patient cases to ensure appropriate utilization of healthcare services, medical necessity, compliance with payer requirements, and optimal patient outcomes. This role collaborates closely with physicians, case managers, and interdisciplinary teams to support quality patient care while managing healthcare resources efficiently.

Key Responsibilities
  • Perform utilization review activities for inpatient and outpatient services.
  • Assess medical necessity, level of care, and appropriateness of admissions using established criteria such as InterQual or MCG guidelines.
  • Collaborate with physicians, case management, and healthcare teams regarding patient care plans and discharge planning.
  • Communicate with insurance providers and third-party payers to obtain authorizations and resolve coverage issues.
  • Monitor patient length of stay and identify opportunities to improve care efficiency.
  • Ensure compliance with hospital policies, federal regulations, and payer requirements.
  • Document utilization review findings accurately and maintain confidentiality of patient information.
  • Participate in denial prevention and appeals processes when necessary.
  • Support quality improvement initiatives and patient care coordination activities.
Qualifications
  • Active Registered Nurse (RN) license in the applicable state.
  • Bachelor of Science in Nursing (BSN) preferred.
  • Minimum 2–3 years of acute care hospital nursing experience required.
  • Prior experience in Utilization Management, Case Management, or Care Coordination preferred.
  • Strong knowledge of InterQual and/or MCG criteria.
  • Experience working with electronic medical records (EMR) systems.
  • Excellent communication, critical thinking, and organizational skills.

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