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Optum Utilization Management Nurse Jobs (NOW HIRING)

CVS Health

Utilization Management Nurse Consultant

$26.01 - $62.32/hr

Utilization Management Nurse Consultant Clinical Precertification RN (Medicare) Remote | Full-Time | Weekday Schedule Are you a Registered Nurse ready to make an impact beyond the bedside? Join our ...

MUSC

Utilization Management Nurse-1

Murrells Inlet, SC · On-site

... Nurse required. Prior leadership experience preferred. One year of case management and/or utilization management work experience preferred. Staff hired prior to July 1, 2013 will be grandfathered in ...

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Optum Utilization Management Nurse information

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$39K

$89.5K

$163K

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

As of Sep 12, 2026, the average yearly pay for optum utilization management nurse 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 Utilization Management Nurse jobs?

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

Utilization Management Nurse

Little Rock, AR • On-site

Paladin Consulting
Recruiting and Staffing Services • 1 - 5K employees
Learn more about Paladin Consultingexternal

Other

Posted 7 days ago

Job description

Duties:
Utilization Management:
  • Conducts and monitors clinical review cases to ensure medical necessity of inpatient and outpatient services, diagnostic procedures, out-of-network services, and surgery; documenting all relevant and specific information; and screens, prioritizes and organizes determination requests according to mandates and standards.
  • Promotes appropriate care and quality toward cost effective and cost containment measures based on evidence.
Communication:
  • Collaborates with healthcare providers and internal staff to promote quality of care, cost effectiveness, accessibility and appropriateness of service levels.
Compliance:
  • Practices nursing within the scope of licensure and adheres to policies, procedures, regulations, URAC standards and individual state regulations; making decisions based on facts and evidence to ensure compliance, appropriate level of care, and patient safety.
Workflow:
  • Proactively and efficiently work incoming and outbound calls and/or queues from multiple sources within mandated requirements.
Knowledge:
  • Remain current with up-to-date medical and surgical procedures, products, healthcare services and drugs, general trends in health care delivery; and enterprise procedures, policies and contracts.
  • Other duties as assigned.
Skills:
  • Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook, including the ability to navigate multiple systems and keyboarding 4.
  • Experience in utilization management and/or medical review preferred.
Specialized Knowledge & Skills:
  • Ability to prioritize and make sound nursing judgments through critical thinking
  • Excellent verbal and written communication skills
  • Ability to build collaborative relationships
  • Attention to details
  • Ability to interpret complex documentation
Education:
  • Registered Nurse License, active and unencumbered state license in the state where job duties are performed is required.
  • BSN preferred. 2. Four (4) years of clinical practice nursing experience in at least one of the following areas: medical-surgical nursing, surgical nursing, intensive care or critical care nursing.

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