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Optum Utilization Review Jobs (NOW HIRING)

UnitedHealth Group

Clinical Claim Review RN

Boston, MA · Remote

$29 - $52/hr

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by

UnitedHealth Group

Clinical Claim Review RN

Boston, MA · On-site

$29 - $52/hr

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by

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Optum Utilization Review information

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$42

$68

How much do optum utilization review jobs pay per hour?

As of Jul 21, 2026, the average hourly pay for optum utilization review 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 are the key skills and qualifications needed to thrive in the Optum Utilization Review position, and why are they important?

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 job?

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 a typical day look like for someone in an Optum Utilization Review position?

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.

More about Optum Utilization Review jobs
What cities are hiring for Optum Utilization Review jobs? Cities with the most Optum Utilization Review job openings:
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Optum Utilization Review jobs near you
Infographic showing various Optum Utilization Review job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 85% Full Time, 12% Part Time, and 2% Summer. Highlights an 92% Physical, and 8% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Drug Rehabilitation Billing Specialist

SM Staffing

Suffern, NY • On-site

$19.75 - $26.50/hr

Full-time

Posted 20 days ago

Job description

Position Overview
The Drug Rehabilitation Billing Specialist owns end-to-end revenue cycle operations for the substance use disorder portfolio, expanding as the portfolio grows. The role focuses on commercial out-of-network (OON) billing across detox, residential, partial hospitalization (PHP), and intensive outpatient (IOP) levels of care.
Core Responsibilities
—  Submit claims end-to-end for detox, residential, PHP, and IOP levels of care across commercial OON payers
—  Monitor claim status, work pending and rejected claims through the clearinghouse, and ensure timely resolution
—  Conduct denial management, including root cause analysis and corrective resubmission
—  Draft and submit appeals for OON denials and underpayments, coordinating with Utilization Review for clinical documentation
—  Post ERAs and patient payments, reconcile against expected reimbursement, and surface underpayments for follow-up
—  Coordinate with Utilization Review Directors and Patient Collections Managers at portfolio facilities
Required Experience
—  Two to five years of hands-on substance use disorder billing experience
—  Demonstrated experience with OON commercial billing, including OON benefits, billed charges, balance billing, and OON reimbursement dynamics
—  Working understanding of single case agreements and their billing implications
—  End-to-end revenue cycle competency including submission, follow-up, denial management, appeals, and payment posting
—  Proficiency with UB-04 facility claims and CMS-1500 professional claims, including bill types, revenue codes, HCPCS codes, modifiers, and place-of-service codes for substance use disorder levels of care
—  Working knowledge of major commercial payers and their behavioral health carve-outs (e.g., Optum BH, Magellan, Evernorth, Carelon)
 
 
Preferred Qualifications
—  Hands-on experience with EHRs, practice management systems, and clearinghouses (Sunwave / Waystar a bonus)
—  Inpatient substance use disorder billing experience
—  Experience billing for facilities operating in Florida or other heavily regulated substance use disorder markets
—  Familiarity with Title 42 CFR Part 2 confidentiality requirements
—  Prior experience at a back-office billing organization or in-house billing team at a multi-facility substance use disorder operator
—  HIPAA workforce member experience and familiarity with PHI handling requirements