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Optum Utilization Review Nurse Jobs in Renton, WA

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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 Aug 30, 2026, the average hourly pay for optum utilization review nurse in Renton, WA is $47.56, according to ZipRecruiter salary data. Most workers in this role earn between $37.60 and $54.62 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.

What are popular job titles related to Optum Utilization Review Nurse jobs in Renton, WA?

For Optum Utilization Review Nurse jobs in Renton, WA, the most frequently searched job titles are:

What job categories do people searching Optum Utilization Review Nurse jobs in Renton, WA look for?

The top searched job categories for Optum Utilization Review Nurse jobs in Renton, WA are:

What cities near Renton, WA are hiring for Optum Utilization Review Nurse jobs?

Cities near Renton, WA with the most Optum Utilization Review Nurse job openings:

NP or PA - Optum Care at Home - Statewide Traveler - | , Washington

Seattle, WA • On-site


Reliant Medical Group
Health Care and Social Assistance • 1 - 5K employees

7.3

Company rating: 7.3 out of 10

Based on 26 frontline employees who took The Breakroom Quiz

People enjoy working here

Good employer

Recommended by parents


$109K - $164K/yr

Other

Medical, Life, Retirement

Posted 4 days ago


Job description

Nurse Practitioner Opportunity

$40,000 Student Loan Repayment OR $40,000 Sign-on Bonus

In Home Care, No Nights, Weekends or Holidays

This role will require weekly overnight travel throughout the state of Washington

Can work Monday-Friday, 8 hour days OR 4 days a week, 10 hour days

Optum Home & Community Care, part of the Optum family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs - helping patients access and navigate care anytime and anywhere. As a team member of our Optum Care at Home team, together in an interdisciplinary care environment, we help patients navigate the health care system and connect them to key support services. This preventive care can help patients stay well at home. This life-changing work adds a layer of support to improve access to care. We're connecting care to create a seamless health journey for patients across care settings. Join us to start Caring. Connecting. Growing together.

The Optum at Home program is a longitudinal, integrated care delivery program that coordinates the delivery and provision of clinical care of patients (beneficiaries) in their place of residence. The APC within OAH provides care to our highest-risk health plan beneficiaries and is part of an interdisciplinary team. We're fast becoming the nation's largest employer of Nurse Practitioners; offering a superior professional environment and incredible opportunities to make a difference in the lives of patients. This growth is not only a testament to our model's success but the efforts, care, and commitment of our Nurse Practitioners.

Primary Responsibilities:
  • Conduct comprehensive in-home assessments, including past medical history review, medication reconciliation, vital signs, and physical exam
  • Evidence-based screenings and point-of-care testing (as appropriate)
  • Manage members through an acute medical situation or an exacerbation of a chronic condition, including testing, diagnostics, interventions
  • Manage members during a short term sub-acute rehabilitation episode
  • Ensure accurate and complete documentation, including ICD 10 conditions
  • Communicate and collaborate with the interdisciplinary care team
  • Conduct advanced illness and advanced care planning conversations
  • Provide patients and caregivers with counseling and education
  • Ability to travel throughout the state up to 85% of the time. Based on business needs with advanced notice, eligible for additional compensation incentives, Monday- Friday - home on weekends

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:
  • For NPs: Active ANCC or AANP certification in Family, Adult, Geriatric, or Adult-Gerontology Primary Care
  • For PAs: Current NCCPA certification and state licensure
  • Active, unrestricted licensure in the state you will be practicing in (or ability to obtain by start date) without current disciplinary actions or practice limitations
  • Active and unrestricted driver's license In addition to a driver's license, access to reliable transportation
  • Current, active DEA licensure/prescriptive authority or ability to obtain post-hire, per state regulations (unless prohibited in state of practice)
  • Ability to gain a collaborative practice agreement, if applicable in your state
  • Ability to navigate varied environments; ability to sit/stand/kneel as needed to perform duties
Preferred Qualifications:
  • 1+ years of clinical experience as an APC (family, geriatric, or home health preferred)
  • Experience in geriatric medicine, long-term care, senior living or home care setting
  • Experience in meeting the medical needs of patients with complex behavioral, social and/or functional needs
  • Understanding of Geriatrics and Chronic Illness
  • Understanding of Advanced Illness and end of life discussions
  • Proficiency with electronic medical records and technology

Compensation for this specialty generally ranges from $109,500 - $164,000. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.



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