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Remote Optum Clinical Review Jobs (NOW HIRING)

WNS Global Services

Nurse - Clinical Review

Houston, TX · On-site +1

$65K - $75K/yr

... Performs clinical reviews according to the policies and procedures of HealthHelp within the ... Remote Benefits - Medical , Dental, & Vision. 401K plan Compensation Disclosure The base salary for ...

WNS Global Services

Nurse - Clinical Review

Houston, TX · Remote

$65K - $75K/yr

Performs clinical reviews according to the policies and procedures of HealthHelp within the ... Remote Benefits - Medical , Dental, & Vision. 401K plan Compensation Disclosure The base salary for ...

Cohere Health

Clinical Review & Correspondence RN

$31 - $35/hr

Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a critical role ... This is a 100% remote role, and requires robust internet speeds (above 50 megabytes/second ...

Comagine

Clinical Reviewer

In this role, you will review clinical documentation to determine medical necessity and ... This is a remote position based in Oregon and travel is required. Why Comagine Health? Comagine ...

TEEMA Group

Clinical Quality Review Nurse

Phoenix, AZ · Remote

$41 - $44/hr

USA- Remote in approved states Overview: TEEMA is partnering with a leading organization supporting a large-scale federal healthcare program to identify a Clinical Quality Reviewer. This role focuses ...

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Remote Optum Clinical Review information

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$14

$34

$90

How much do remote optum clinical review jobs pay per hour?

As of Jul 7, 2026, the average hourly pay for remote optum clinical review in the United States is $34.62, according to ZipRecruiter salary data. Most workers in this role earn between $16.59 and $32.93 per hour, depending on experience, location, and employer.

How does a Remote Optum Clinical Review professional typically collaborate with interdisciplinary teams while working from home?

Remote Optum Clinical Review professionals frequently collaborate with physicians, nurses, case managers, and other healthcare staff through virtual meetings, secure messaging, and shared electronic health records. Effective communication skills are essential, as most interactions are conducted remotely. Team members regularly participate in cross-functional discussions to review patient cases, ensure compliance with clinical guidelines, and make evidence-based recommendations. Despite working from home, there is a strong emphasis on teamwork and maintaining alignment with organizational goals and regulatory standards.

What is the difference between Remote Optum Clinical Review vs Remote Optum Utilization Review?

AspectRemote Optum Clinical ReviewRemote Optum Utilization Review
CertificationsRN, LPN, or other clinical licensesRN, LPN, or other clinical licenses
Work EnvironmentHome-based, healthcare settingHome-based, healthcare setting
Employer & IndustryOptum, healthcare insurance and managed careOptum, healthcare insurance and managed care
Primary FocusAssessing clinical necessity and appropriateness of careReviewing medical necessity for insurance coverage

Both roles involve remote work within the healthcare insurance industry, requiring clinical licenses. The main difference is that Clinical Review focuses on evaluating the appropriateness of care, while Utilization Review emphasizes determining medical necessity for insurance purposes.

What is a Remote Optum Clinical Review?

A Remote Optum Clinical Review is a job where healthcare professionals, such as nurses or physicians, evaluate medical records and treatment plans from a remote location. The goal is to ensure that healthcare services and procedures meet established clinical guidelines and are medically necessary. These reviews help determine coverage decisions for insurance claims and improve patient outcomes. Team members work from home, using secure systems to review documentation and collaborate with clinicians or insurance representatives. Optum is a part of UnitedHealth Group, and their clinical reviewers play a key role in maintaining quality and compliance in healthcare delivery.

What are the key skills and qualifications needed to thrive as a Remote Optum Clinical Review Nurse, and why are they important?

To thrive as a Remote Optum Clinical Review Nurse, you need a valid RN license, strong clinical judgment, and experience in utilization management or case review. Familiarity with clinical review software, electronic health records (EHRs), and knowledge of medical necessity criteria like MCG or InterQual is typically required. Excellent attention to detail, critical thinking, and effective communication are key soft skills for evaluating cases and collaborating with healthcare teams. These skills ensure accurate clinical assessments, compliance with regulations, and improved patient care outcomes in a remote environment.
More about Remote Optum Clinical Review jobs
What cities are hiring for Remote Optum Clinical Review jobs? Cities with the most Remote Optum Clinical Review job openings:
What are the most commonly searched types of Optum Clinical Review jobs? The most popular types of Optum Clinical Review jobs are:
What states have the most Remote Optum Clinical Review jobs? States with the most job openings for Remote Optum Clinical Review jobs include:
What job categories do people searching Remote Optum Clinical Review jobs look for? The top searched job categories for Remote Optum Clinical Review jobs are:
Remote Optum Clinical Review jobs near you
Infographic showing various Remote Optum Clinical Review job openings in the United States as of July 2026, with employment types broken down into 3% As Needed, 72% Full Time, 18% Part Time, and 7% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $72,002 per year, or $34.6 per hour.
Clinical Review Nurse - Remote

Clinical Review Nurse - Remote

ARC Group

Jacksonville, FL • Remote

Full-time

Posted 23 days ago

Job description

CLINICAL REVIEW NURSE - REMOTE
ARC Group has multiple positions open for Clinical Review Nurses! These positions are 100% remote. These are direct hire FTE positions with salary, benefits, etc. This is a fantastic opportunity to join a dynamic and well-respected organization offering tremendous career growth potential.
At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply.
100% REMOTE!
Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering).
SUMMARY STATEMENT
The Clinical Review Nurse is responsible for reviewing and making medical determinations as to the validity of health claims and levels of payment in meeting national and local policies as well as accepted medical standards of care. The incumbent applies clinical knowledge to assess the medical necessity, level of services and appropriateness of care which may include cases requiring prior authorization, complex pre-payment medical review or post-payment medical review.
ESSENTIAL DUTIES & RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.
90% of time will be spent on one or more of the following activities depending on assignments:
Review and analyze pre and post pay complex health care claims from a medical perspective, inclusive of prior authorization:
  • Perform clinical review work as assigned; may provide guidance to other team members and accurately interpret and apply broad CMS guidelines to specific and highly variable situations.
  • Conduct review of claim data and medical records to make clinical decisions on the coverage, medical necessity, utilization and appropriateness of care per national and local policies, as well as accepted medical standards of care.
  • Review provider practices and identify issues of concern, overpayment and need for corrective action as necessary; includes surfacing potential fraud and abuse or practice concerns.
  • May develop recommendations for further corrective action based on medical review findings.
  • May refer for review, or implement, corrective action related to medical review activities.
  • May process claims and complete project work in the appropriate computer system(s).

The remaining 10% of time will be spent on the following activities depending on assignments:
Identify providers needing education and individually educate providers who are subject to medical
review processes:
  • Initiate or participate in provider teaching activities, creating written teaching material, providing one on one education or education to a group as a result of a medical review (e.g., probe, progressive corrective action, consent, etc.) or appeal.
  • This may involve discussion with CMS leaders and leaders in the provider community.
  • Participate in special projects as assigned.

REQUIRED QUALIFICATIONS
* Valid nursing degree
* 2 years' clinical experience
* Excellent written and oral communication skills
* Demonstrated experience with evaluating medical and health care delivery issues (e.g., Inpatient Rehab Facility)
* Strong computer skills to include Microsoft Office proficiency
* Valid unrestricted Registered Nurse (RN) license
PREFERRED QUALIFICATIONS
* Inpatient Rehabilitation Facility Experience
* Bachelor of Science in Nursing (BSN)
* Insurance industry experience
* Certified Coder
ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed.
At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know.
Position is offered with no fee to candidate.