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How much do optum utilization review jobs pay per hour?

As of Aug 10, 2026, the average hourly pay for optum utilization review in California is $41.73, according to ZipRecruiter salary data. Most workers in this role earn between $32.98 and $47.93 per hour, depending on experience, location, and employer.

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

To succeed in an Optum Utilization Review role, candidates typically need a clinical background such as a registered nurse (RN) or social worker (LCSW), along with experience in case management and knowledge of utilization management principles. Familiarity with medical review software, electronic health records (EHRs), and utilization management platforms like InterQual or Milliman is often expected, as well as active state licensure or relevant certifications (e.g., CCM). Strong analytical thinking, attention to detail, and effective communication are critical soft skills for collaborating with healthcare providers and internal teams. These competencies are vital to ensure appropriate use of healthcare resources, compliance with regulations, and optimal patient outcomes.

What is an Optum Utilization Review?

An Optum Utilization Review job involves assessing medical treatments and services to ensure they are medically necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this role review patient cases, collaborate with healthcare providers, and apply clinical criteria to determine coverage approvals. They help optimize patient care while managing healthcare costs. Typically, these positions require a background in nursing or healthcare and knowledge of utilization management policies.

What does an Optum Utilization Review do?

In an Optum Utilization Review position, you can expect a mix of reviewing patient medical records, communicating with healthcare providers to gather additional information, and making decisions on the medical necessity and appropriateness of services. The role often involves using clinical guidelines and established protocols to ensure coverage aligns with insurance policies, as well as accurate documentation of findings and recommendations. You'll collaborate with physicians, other case managers, and sometimes directly with members, in a structured yet dynamic environment. While much of the work may be independent and computer-based, teamwork and communication are essential to coordinate care and resolve complex cases.

What are the most commonly searched types of Optum Utilization Review jobs in California? The most popular types of Optum Utilization Review jobs in California are:
What are popular job titles related to Optum Utilization Review jobs in California? For Optum Utilization Review jobs in California, the most frequently searched job titles are:
What job categories do people searching Optum Utilization Review jobs in California look for? The top searched job categories for Optum Utilization Review jobs in California are:
What cities in California are hiring for Optum Utilization Review jobs? Cities in California with the most Optum Utilization Review job openings:
Optum Utilization Review jobs near you
Infographic showing various Optum Utilization Review job openings in California as of August 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 $86,795 per year, or $41.7 per hour.

RN, Care Manager, Utilization Management (Full-time, Remote)

Adventist Health

Roseville, CA • On-site

Other

Posted 7 days ago

Adventist Health rating

7.7

Company rating: 7.7 out of 10

Based on 243 frontline employees who took The Breakroom Quiz

158th of 887 rated healthcare providers

Job description

Job Title

Plays a critical role in ensuring that patients receive high-quality care while efficiently utilizing medical resources.

Job Description

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Reviews patient medical records, assessing the appropriateness and necessity of proposed treatments, and collaborating with healthcare providers and insurance companies to ensure a seamless care experience and the practicing of financial stewardship and denial prevention. Focuses on maximizing patient outcomes and optimizing resource allocation. Utilizes exceptional clinical knowledge, excellent communication skills, and the ability to thrive in a fast-paced and ever-changing healthcare environment.

Job Requirements

Education and Work Experience:

  • Associate's Degree in nursing or equivalent combination of education/related experience: Required
  • Bachelor's Degree in Nursing (BSN): Preferred
  • Five years' acute hospital experience required with preferred experience in critical care areas: Required
  • Two years' utilization review experience using the Optum/Inter Qual product within the last 12 months: Required

Licenses/Certifications:

  • Registered Nurse (RN) licensure in the state of practice: Required
Essential Functions
  • Completes clinical reviews of acute medical patients using the Optum/Inter Qual tool to determine if the patient is in the right acute setting, receiving the right acute services, during the appropriate length of stay.
  • Participates in annual Optum/Inter Qual training required. Takes the required annual Optum/Inter Qual Interrater Reliability (IRR) test with a minimum passing score as defined in the yearly departmental goals.
  • Meets weekly productivity metrics within 90 days of completing orientation and maintains on a weekly basis as defined in the yearly departmental goals. Meets quality audit metrics within 90 days of completing orientation and maintained on the audit cadence set within the department as defined in the yearly departmental goals.
  • Completes all required departmental education assigned with timeliness and accuracy. Follows all departmental workflows in communication variances to the on-site care management teams when appropriate. Reviews and analyzes medical records to assess the necessity and appropriateness of treatments and interventions.
  • Collaborates with healthcare professionals to develop and implement comprehensive patient care plans. Facilitates communication between the patient, healthcare team, insurance providers, and other stakeholders to ensure a coordinated and efficient care process. Stays up to date with the latest healthcare regulations, insurance guidelines, and evidence-based practices to ensure the delivery of optimal healthcare services.
  • Performs other job-related duties as assigned.
Organizational Requirements

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

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