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Optum Utilization Review Nurse Jobs (NOW HIRING)

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care. Overview Seeking an experienced Utilization Review Nurse (RN) to review patient admissions ...

Sentara Health Plans

$10K/mo

The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical ...

Merrimack Health

Utilization Review Nurse

Methuen, MA · On-site

Utilization Review Nurse Responsible for determining the appropriateness of hospital admission, utilization of resources and medical necessity for continued stay. Responsible for working with the ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines ...

Cobalt Benefits Group

Utilization Review Nurse

Utilization Review Nurse Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a Utilization Review Nurse, you'll play an important role in ...

Acrisure, LLC

Utilization Review Nurse, LPN** to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines and regulatory ...

Acrisure, LLC

Utilization Review Nurse

Bradenton, FL · On-site

Utilization Review Nurse, LPN** to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines and regulatory ...

Acrisure

Utilization Review Nurse

Bradenton, FL

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines ...

Acrisure LLC

Utilization Review Nurse

Bradenton, FL · On-site

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines ...

UCI Health

RN - Utilization Review

Orange, CA · On-site

Utilization Review Nurse A utilization review nurse is a registered nurse (RN) who is responsible for ensuring patients receive necessary care without performing unnecessary or duplicate services.

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Optum Utilization Review Nurse information

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

As of Sep 14, 2026, the average hourly pay for optum utilization review nurse 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 does an Optum Utilization Review Nurse do?

An Optum Utilization Review Nurse is responsible for reviewing medical records and patient cases to ensure that healthcare services provided are medically necessary and compliant with insurance guidelines. They evaluate treatment plans, collaborate with healthcare providers, and help determine coverage decisions for patients. By assessing the appropriateness of care, they help manage healthcare costs and improve patient outcomes. Their work involves communication with physicians, patients, and insurance representatives to ensure efficient and effective care delivery.

What are the key skills and qualifications needed to thrive as an Optum Utilization Review Nurse?

To thrive as an Optum Utilization Review Nurse, you need strong clinical assessment skills, a current RN license, and experience in case management or utilization review. Familiarity with clinical documentation systems, InterQual or Milliman Care Guidelines, and managed care regulations is typically required. Attention to detail, critical thinking, and effective communication are crucial soft skills for this role. These competencies are vital to ensure appropriate care decisions, regulatory compliance, and collaboration with interdisciplinary teams for optimal patient outcomes.

How does an Optum Utilization Review Nurse typically collaborate with physicians and other healthcare professionals during the review process?

As an Optum Utilization Review Nurse, you will frequently interact with physicians, case managers, and other healthcare providers to assess the medical necessity and appropriateness of patient care. This collaboration often involves reviewing clinical documentation, participating in multidisciplinary meetings, and communicating findings or recommendations to ensure quality and cost-effective care. Building strong professional relationships and maintaining clear, respectful communication are key to facilitating smooth care transitions and achieving optimal patient outcomes. This collaborative approach helps ensure that all parties are aligned with evidence-based guidelines and organizational policies.

What is the difference between Optum Utilization Review Nurse vs Optum Case Manager?

AspectOptum Utilization Review NurseOptum Case Manager
CredentialsRN license, certifications in case management or utilization review often preferredRN license, case management certification often preferred
Work EnvironmentReviewing medical records, assessing insurance claims, working in healthcare or insurance settingsCoordinating patient care, managing cases, working in healthcare or insurance settings
Employer & IndustryHealth insurance companies, healthcare providers, utilization review departmentsHealth insurance companies, healthcare organizations, patient advocacy

Optum Utilization Review Nurses primarily evaluate medical necessity and approve or deny insurance claims, focusing on utilization review. In contrast, Optum Case Managers coordinate patient care, develop treatment plans, and support patient needs. Both roles require nursing credentials and work within healthcare or insurance environments, but their core responsibilities differ in focus and scope.

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Optum Utilization Review Nurse jobs near you
Infographic showing various Optum Utilization Review Nurse job openings in the United States as of September 2026, with employment types broken down into 100% Full Time. Highlights an 75% In-person, and 25% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse

Las Vegas, NV • On-site

Fusion HCR
Human Resources Consulting Services • 11 - 50 employees
Learn more about Fusion HCRexternal

Other

Re-posted 8 days ago

Job description

Fusion HCR is hiring!Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care.
Overview
Seeking an experienced Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate level of care, and compliance with payer guidelines. This role works closely with clinical teams to ensure efficient resource utilization and quality patient outcomes.
Responsibilities
  • Review admissions using InterQual and/or Milliman criteria
  • Evaluate medical necessity, level of care, and documentation accuracy
  • Ensure compliance with Medicare, Medicaid, and regulatory guidelines
  • Collaborate with physicians, case management, and care teams
  • Support discharge planning and care coordination
  • Document findings and communicate recommendations

Requirements
  • Active RN license (Nevada)
  • 5+ years acute care nursing experience
  • 3+ years Utilization Review experience
  • 3+ years discharge planning experience (acute care)
  • Experience with InterQual (must be able to pass exam)
  • Experience with Milliman guidelines

Preferred
  • Background in Case Management or CDI
  • Strong knowledge of Joint Commission and CMS guidelines

Why Apply
  • Competitive pay
  • Stable, high-demand role
  • Collaborative healthcare environment

Apply Now
If you have strong Utilization Review, InterQual, and acute care experience, we want to hear from you!

Apply