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Remote Optum Clinical Review Jobs in Decatur, GA

micro1 AI

Clinician (Oncology / Hematology)

Atlanta, GA · Remote

$160 - $200/hr

Remote micro1 is engaging Clinician (Oncology / Hematology)s to contribute to a customer's project ... Scope of Work * Author and review evaluation tasks that require nuanced clinical judgment ...

New

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois ... Complete medical necessity reviews and level of care reviews for requested services using clinical ...

micro1 AI

Hematologist / Oncologist

South Fulton, GA · Remote

$160 - $200/hr

Clinician (Oncology / Hematology) Role Type: Contractor Location: Remote micro1 is engaging ... Scope of Work * Author and review evaluation tasks that require nuanced clinical judgment ...

New

micro1 AI

Hematologist / Oncologist

Sandy Springs, GA · Remote

$160 - $200/hr

Clinician (Oncology / Hematology) Role Type: Contractor Location: Remote micro1 is engaging ... Scope of Work * Author and review evaluation tasks that require nuanced clinical judgment ...

New

micro1 AI

Hematologist / Oncologist

Atlanta, GA · Remote

$160 - $200/hr

Clinician (Oncology / Hematology) Role Type: Contractor Location: Remote micro1 is engaging ... Scope of Work * Author and review evaluation tasks that require nuanced clinical judgment ...

New

Insight Global

Remote Pharmacy Technician

Atlanta, GA · Remote

$20.50/hr

This role involves receiving and reviewing authorization requests via phone, fax, and electronic systems, gathering and verifying clinical information, documenting interactions, evaluating requests ...

Insight Global

Remote Pharm Tech

Atlanta, GA · Remote

$20.50/hr

This role involves receiving and reviewing authorization requests via phone, fax, and electronic systems, gathering and verifying clinical information, documenting interactions, evaluating requests ...

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Remote Optum Clinical Review information

See Decatur, GA salary details

$14

$33

$88

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

As of Aug 7, 2026, the average hourly pay for remote optum clinical review in Decatur, GA is $33.80, according to ZipRecruiter salary data. Most workers in this role earn between $16.20 and $32.16 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.
What are popular job titles related to Remote Optum Clinical Review jobs in Decatur, GA? For Remote Optum Clinical Review jobs in Decatur, GA, the most frequently searched job titles are:
What job categories do people searching Remote Optum Clinical Review jobs in Decatur, GA look for? The top searched job categories for Remote Optum Clinical Review jobs in Decatur, GA are:
What cities near Decatur, GA are hiring for Remote Optum Clinical Review jobs? Cities near Decatur, GA with the most Remote Optum Clinical Review job openings:
Remote Optum Clinical Review jobs near you

Market Chief Medical Officer Medicare and Retirement - AL/GA/SC/TN - Remote

UnitedHealth Group

Atlanta, GA • On-site, Remote

Full-time

Medical, Retirement

Re-posted 22 days ago

UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

189th of 887 rated healthcare providers

Job description

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The Market Chief Medical Officer (CMO) is the senior clinical executive for the designated Medicare & Retirement (M&R) market. The CMO is accountable for clinical strategy and performance across affordability, quality, population health, growth, member experience, and external clinical relationships within the market.
The CMO serves as the senior market clinical leader responsible for aligning United Healthcare (UHC), United Clinical Services (UCS), and Optum clinical capabilities to advance clinical affordability, improve HEDIS and CMS Star performance, reduce unwarranted utilization, and strengthen provider partnership across the market.
The CMO partners closely with the market CEO, the market Senior Leadership Team, UCS leadership, and matrixed partners across Network, Sales, and regional functions to translate enterprise priorities into market strategy, execution, and measurable results for the Medicare line of business. The CMO reports to the Regional Chief Medical Officer with dotted-line accountability to the local market CEO.
If you are located in in AL/GA/SC/TN, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
  • Clinical Performance and Affordability - The CMO provides executive leadership for clinical performance, utilization strategy, and affordability across the market. This includes partnering with hospitals, physicians, physician groups, and internal stakeholders to improve efficiency, reduce unwarranted variation, and advance value. The CMO also drives performance across market ACOs and delegated medical groups, with accountability for improving HEDIS and CMS Star outcomes and strengthening value realization at the market level
  • Quality, Outcomes, and Clinical Performance - The CMO drives market performance on key quality, experience, and clinical outcome measures, including HEDIS, CAHPS, Quality Improvement Programs (QIPs), and CMS Star priorities. The role serves as a catalyst for continuous improvement, ensuring clinical strategy translates into measurable results. The CMO also partners with providers on evolving priorities, measure updates, and peer review activities, including Quality of Care and Quality of Service matters
  • External Affairs and Strategic Partnerships - The CMO maintains solid working knowledge of government mandates and regulatory requirements and works across the enterprise to ensure compliant clinical programs and practices. The CMO serves as a visible and trusted clinical leader with providers, health systems, and other external stakeholders, strengthening strategic partnerships and advancing market priorities.
    Clinical Transformation and Innovation - The CMO leads the clinical partnership with care providers and UHC network management colleagues to advance health system transformation. This includes accountable care strategies, value-based arrangements, clinical practice transformation, transparency initiatives, innovative care models, high-performance networks, consumer engagement, and value-based benefit design
  • Growth, Market Development, and Clinical Value - The CMO articulates and advances the clinical value proposition in support of market growth, sales strategy, and stakeholder engagement. This includes representing the clinical perspective in broker and client discussions, informing program and product design through market insight, and strengthening relationships with state and local regulatory authorities and medical societies
  • Performance Management and Continuous Improvement - The CMO identifies and prioritizes improvement opportunities through market and regional performance reviews and drives action plans to address gaps and accelerate results. The role provides leadership for continuous improvement initiatives and ensures disciplined execution, accountability, and sustained progress across clinical and affordability priorities

Executive Leadership Capabilities:
  • Proven executive leadership experience in clinical management within a health system, hospital, large physician organization, or similarly complex care delivery environment
  • Demonstrated ability to lead change and innovation by identifying opportunities, implementing new solutions, and creating a culture that embraces transformation, agility, and continuous improvement
  • Proven ability to lead through influence in a matrixed environment, build high-performing teams, and develop talent through coaching, feedback, and accountability
  • Solid execution discipline with the ability to translate strategy into action, monitor performance closely, manage financial implications, and ensure accountability for results
  • Demonstrated commitment to integrity, compliance, and sound clinical and business judgment
  • Track record of delivering measurable improvement against clinical, operational, and business objectives
  • Ability to establish credibility and solid partnerships with network physicians, community providers, and health system clinical leadership
  • Visible, credible presence in the medical community and with external clinical stakeholders
  • Ability to lead effectively across a complex matrixed organization and align diverse stakeholders around shared priorities

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:
  • Active and unrestricted medical license in Georgia, Alabama, South Carolina, or Tennessee
  • Active and unrestricted Board Certification in an ABMS or AOBMS specialty
  • 5+ years clinical practice experience; solid knowledge of managed care industry
  • Ability/experience in developing collaborative relationships with health system clinical leadership
  • Familiarity with current medical issues and practices
  • Solid knowledge of health care utilization data and analytics
  • Proficiency with Microsoft Office applications (Outlook, Word, Excel, PowerPoint)
  • Proven excellent executive communication skills with the ability to influence senior leaders and represent complex clinical issues clearly to diverse audiences
  • Proven solid analytical orientation with the ability to identify performance opportunities through data, implement solutions, and deliver measurable impact
  • Demonstrated executive presence and enterprise mindset, with the ability to build alignment across functions and drive results in a matrixed environment
  • Proven partners closely with the market CEO and leadership team to achieve financial, quality, and market performance goals
  • Proven superior presentation skills for both clinical and non-clinical audiences
  • Proven ability to build and sustain solid relationships with network physicians, community providers, and other key clinical partners
  • Proven solid data analysis and interpretation skills; ability to focus on key metrics
  • Proven solid leadership and team-building capabilities, with the ability to align teams around a clear vision and shared accountability
  • Proven strategic thinking with proven ability to communicate a vision and drive results
  • Proven solid negotiation and conflict management skills
  • Proven creative problem-solving skills
  • Willing or ability to travel within the assigned markets

Preferred Qualifications:
  • Advanced Business, Public Health, Medical Management degree
  • Health plan experience
  • Knowledge of health plan finance, CMS Star performance, and accurate coding

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $292,300 - $438,500 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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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