ZipRecruiter

Log In

2

Remote Optum Clinical Review Jobs in Decatur, GA

TRC Talent Solutions

Pro JTS - Remote Coder

Atlanta, GA · Remote

$18 - $24/hr

Encoder experience required, preferably 3M, Codify or Optum but will also consider other encoder ... Electronically receives assigned medical charts to code Reviews, analyzes, and interprets the ...

New

LivaNova

Regulatory & Clinical Specialist

Atlanta, GA · Remote

$85K - $95K/yr

The Regulatory and Clinical Specialist will support the clinical evaluation activities, review ... This is a remote role (candidates must be based in the United States) * Occasional travel may be ...

previous page

Showing results 41-60

All JobsOptum Clinical Review JobsRemote Optum Clinical Review JobsRemote Optum Clinical Review Jobs in Decatur, GA

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

Pro JTS - Remote Coder

TRC Talent Solutions

Atlanta, GA • Remote

$18 - $24/hr

Full-time

Posted 2 days ago

New

Job description

JTS is hiring a Level 3 Remote Coder (Outpatient Coders with 3+ years of experience wiiling to train to become Inpatient Coders)
***This remote role offers a unique career growth opportunity: current outpatient coders will receive hands-on training and one-on-one mentoring to build inpatient coding expertise over a 9-month development period. Upon successful completion, candidates transition into a permanent Inpatient Coder position a clear, supported pathway to advance your coding career with JTS.All candidates must possess and maintain certification through either the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC.)***
Level 3 coding candidates must have 3+ years outpatient coding experience with expertise in Same Day (Outpatient Surgery) and Observation encounters. Ancillary encounter coding may also be expected.Encoder experience required, preferably 3M, Codify or Optum but will also consider other encoder experience. Experience working with Cerner required.
Primary Responsibilities:
Electronically receives assigned medical charts to code
Reviews, analyzes, and interprets the medical record for the current encounter, identifying all diagnoses and procedures documented.
Deliver expertise in same day surgery (outpatient surgery) coding with extensive knowledge in principles of medical necessity and modifier guidelines.
Deliver expertise in observation coding with extensive knowledge in principals of medical necessity and modifier guidelines as well as observation hour charging and carve-out criteria
Delivers expertise in ancillary coding with extensive knowledge in principles of medical necessity and modifier guidelines, as required by assignment.
Assigns and sequences ICD-10-CM diagnosis and CPT/HCPCs codes in accordance with the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and in compliance with ICD-10 Official Coding Guidelines, Uniform Hospital Discharge Data Set (UHDDS) and other regulatory requirements
Demonstrate proficiency in coding including ICD-10-CM, CPT and HCPCs while consistently maintaining a 95% or greater accuracy score.
Researches and resolves assigned coding projects
Performs ongoing analysis of medical record charts for coding compliance
Maintain productivity based on national standards and/or client-specific standards
Possesses the ability to work independently with little to no supervision
Satisfactorily performs other duties as required and assigned
Required Qualifications:
High school diploma or GED
3+ years of medical coding experience in outpatient coding to include Same Day Surgery (outpatient surgery) and observation coding with ability to also code ancillary, emergency department and/or professional fee encounters
Extensive knowledge of medical terminology, anatomy and physiology, and ancillary test results.
Extensive knowledge of, but not limited to: current Official Coding Guidelines and methodologies, ICD-10-CM/CPT/HCPCs coding guidelines and conventions.
Extensive knowledge of coding systems and regulatory requirements of the Outpatient Prospective Payment System (OPPS)
Extensive knowledge of medical necessity edits, CCI edits and modifier usage.
Extensive knowledge of CPT guidelines regarding the coding of injections and infusions in the outpatient setting
Required Coding certification to include at least one (1) the following:
American Health Information Management Association (AHIMA) Credentials
CCS (Certified Coding Specialist)
RHIA (Registered Health Information Administrator)
RHIT (Registered Health Information Technician)
American Academy of Professional Coders (AAPC) Credentials
CPC (Certified Professional Coder)
COC (Certified Outpatient Coder)
Microsoft Office proficiency to include Teams, Word, Outlook and Excel
Strong communication skills (interpersonal, verbal and written)
Strong organizational and analytical thinking skills
High speed internet and secure home office space (documentation required)
Passing score for online coding proficiency test required
40 hours (Full-time) availability weekly
Preferred Qualifications:
Facility-based coding experience
Professional fee coding experience
Encoder experience
Experience with electronic health records including but not limited to: Cerner, EPIC, Meditech, AllScripts, McKesson
Note: The purpose of this document is to describe the general nature of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.
JTS Health Partners (JTS) is a healthcare professional services and analytics firm focused on Revenue Cycle Management (RCM), Health Information Management (HIM), Health Information Technology (HIT), Healthcare Analytics as a Service (AaaS) and Financial Technology (FinTech). JTS offers consulting, operational and analytical services that align with performance improvement initiatives of healthcare systems, hospitals and physician practices. At JTS, we create the WOW factor for each other and our clients. We embrace a culture where employees are empowered to be innovative and grow personally and professionally.
JTS is an Equal Opportunity Employer encouraging diversity in the workplace. All qualified applicants will receive consideration for employment without regard to race; color; religion; national origin; sex; pregnancy; sexual orientation; gender identity and/or expression; age; disability; genetic information, citizenship status; military service obligations or any other category protected by applicable federal, state, or local law. JTS makes hiring decisions based solely on qualifications, merit, business needs.