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Remote Optum Clinical Review Jobs in Decatur, GA

Pharmacy Careers

MTM Pharmacist

Atlanta, GA · On-site +1

$56 - $67.25/hr

Many MTM pharmacist positions offer remote or hybrid work. * Impact: Directly improve patient ... clinical review, or population health. About Us We partner with health plans, PBMs, and healthcare ...

Pharmacy Careers

MTM Pharmacist

Lawrenceville, GA · On-site +1

$50.25 - $60.50/hr

Many MTM pharmacist positions offer remote or hybrid work. * Impact: Directly improve patient ... clinical review, or population health. About Us We partner with health plans, PBMs, and healthcare ...

Pharmacy Careers

MTM Pharmacist

Atlanta, GA · On-site +1

$56 - $67.25/hr

Many MTM pharmacist positions offer remote or hybrid work. * Impact: Directly improve patient ... clinical review, or population health. About Us We partner with health plans, PBMs, and healthcare ...

Pharmacy Careers

MTM Pharmacist

Atlanta, GA · On-site +1

$56 - $67.25/hr

Many MTM pharmacist positions offer remote or hybrid work. * Impact: Directly improve patient ... clinical review, or population health. About Us We partner with health plans, PBMs, and healthcare ...

CGI Inc.

Remote Clinical Nurse Auditor

Atlanta, GA · On-site +1

Remote Clinical Nurse Auditor Category: Analytics and Emerging Digital Technologies Main location ... In this role, you will be responsible for reviewing medical records to determine the medical ...

Integrated Resources INC

Case Manager

Alpharetta, GA · Remote

$19.50 - $25.25/hr

Under general supervision, and in collaboration with other members of the clinical team, reviews ... The Alpharetta, GA candidate will also have the ability to work remote. This is an inbound ...

OncoHealth

Case Review Specialist - Atlanta

Atlanta, GA · On-site +1

Process cases and request/maintain clinical documentation and transmit timely determinations via ... Experience working remote independently * A minimum of 2-4 years' administrative experience and/or ...

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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 May 31, 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.

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.

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 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 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 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

Remote Prior Authorization Pharmacist

Pharmacy Careers

Atlanta, GA • Remote

$56 - $67.25/hr

Other

Posted 7 days ago

Job description

Remote Prior Authorization Pharmacist - Work From Home in Managed Care
A confidential managed care organization is seeking a motivated Remote Prior Authorization Pharmacist to evaluate prescription requests, ensure medical necessity, and improve patient access to safe and effective therapies. This work-from-home position is ideal for pharmacists who want to transition out of retail or hospital settings while building expertise in managed care.
Key Responsibilities

  • Review prior authorization requests for accuracy, appropriateness, and clinical necessity.
  • Apply plan criteria, evidence-based guidelines, and regulatory standards to determinations.
  • Communicate approval/denial decisions clearly to providers and patients.
  • Collaborate with physicians, nurses, and medical directors on complex cases.
  • Document outcomes in compliance with health plan policies and CMS/state regulations.
  • Support process improvements to streamline workflow and turnaround times.


What You'll Bring

  • Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree.
  • Licensure: Active and unrestricted pharmacist license in the U.S.
  • Experience: Prior authorization, utilization management, or managed care preferred - retail or hospital pharmacists with strong clinical judgment are encouraged to apply.
  • Skills: Excellent clinical review, documentation, and communication skills.

Why This Role?

  • Flexibility: 100% remote work from home with flexible scheduling options.
  • Impact: Directly influence patient access to safe and cost-effective medications.
  • Growth: Build specialized skills in utilization management and managed care.
  • Rewards: Competitive compensation, benefits, and career advancement opportunities.


About Us
We are a confidential healthcare partner working with health plans and PBMs across the U.S.. Our pharmacists ensure patients receive the right therapy at the right time while maintaining compliance with all regulations.
Apply Today
Take the next step in your career with our Remote Prior Authorization Pharmacist opportunity - and enjoy the benefits of working from home while shaping the future of managed care.

Apply