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How much do optum utilization review jobs pay per hour?

As of Aug 30, 2026, the average hourly pay for optum utilization review in Texas is $39.39, according to ZipRecruiter salary data. Most workers in this role earn between $31.15 and $45.24 per hour, depending on experience, location, and employer.

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 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 are the most commonly searched types of Optum Utilization Review jobs in Texas?

The most popular types of Optum Utilization Review jobs in Texas are:

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For Optum Utilization Review jobs in Texas, the most frequently searched job titles are:

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The top searched job categories for Optum Utilization Review jobs in Texas are:

What cities in Texas are hiring for Optum Utilization Review jobs?

Cities in Texas with the most Optum Utilization Review job openings:

Optum Utilization Review jobs near you
Infographic showing various Optum Utilization Review job openings in Texas as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 14% Part Time, 4% Contract, and 2% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $81,936 per year, or $39.4 per hour.

UR LVN Utilization/Clinical Claim Review NurseSeybold Clinic

Pearland, TX • On-site

UnitedHealthcare
Health Care and Social Assistance • 10K+ employees

7.8

Company rating: 7.8 out of 10

Based on 702 frontline employees who took The Breakroom Quiz

131st of 895 rated healthcare providers

People enjoy working here

Good employer

Recommended by students

Learn more about UnitedHealthcareexternal

$20 - $36/hr

Other

Medical, Retirement

Posted 8 days ago

Job description

Utilization Review Lvn Nurse

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.

The Utilization Review LVN nurse will perform documentation review for medical necessity and benefit correlation of requested medical and surgical procedures, services and admissions for HMO, PPO and POS products. The UR LVN nurse will serve as facilitator of communication with clinic, payor and other customers.

Primary Responsibilities:

  • Data entry of all UR requests into the Kelsey-Seybold data system
  • Verifies eligibility
  • Obtains benefit interpretation from insurance company
  • Reviews request and chart to determine medical necessity by using internal criteria
  • Approves request or defers to insurance review and assists with MD review
  • Communicates with respective payor to obtain pre-certification authorization
  • Serves as resource to physicians, staff and patients regarding review process
  • Clarifies UR request discrepancies with office submitting or insurance company
  • Other duties as assigned

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:

  • Licensed Vocational Nurse
  • CEU requirement
  • TX LVN license
  • 2+ years of utilization review experience at heath plan, ACO, IPA, or provider group OR 3+ years of diverse clinical experience, including acute care or similar care
  • Good organization and communication skills
  • HMO, PPO and POS insurance knowledge
  • Valid Driver's license

Preferred Qualifications:

  • Computer and Coding experience

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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). The hourly pay for this role will range from $20.00 to $36.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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. OptumCare 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.

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

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