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Remote Optum Clinical Review Jobs in Silver Spring, MD

RELI Group Inc.

Medical Review Nurse III

Baltimore, MD · On-site +1

$80K - $95K/yr

A minimum of three (3) years clinical experience in an acute care hospital, skilled nursing ... Ability to work well in a remote team environment, to collaborate with others, and interface with ...

RELI GROUP INC

Medical Review Nurse III

Baltimore, MD · Remote

A minimum of three (3) years clinical experience in an acute care hospital, skilled nursing ... Ability to work well in a remote team environment, to collaborate with others, and interface with ...

CareFirst

Clinical Pharmacist (Remote)

Baltimore, MD · Remote

$117K - $140K/yr

Perform comprehensive medication and clinical reviews to identify opportunities for optimization, safety, and adherence. Support resolution of clinical and administrative barriers, including prior ...

UnitedHealth Group

Senior Medical Coder

Washington, DC · Remote

$24 - $43/hr

Optum is a global organization that delivers care, aided by technology, to help millions of people ... Remote Nationwide You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as ...

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Remote Optum Clinical Review information

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$14

$35

$93

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

As of Sep 4, 2026, the average hourly pay for remote optum clinical review in Silver Spring, MD is $35.79, according to ZipRecruiter salary data. Most workers in this role earn between $17.16 and $34.04 per hour, depending on experience, location, and employer.

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.

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 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 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 Silver Spring, MD?

For Remote Optum Clinical Review jobs in Silver Spring, MD, the most frequently searched job titles are:

What job categories do people searching Remote Optum Clinical Review jobs in Silver Spring, MD look for?

The top searched job categories for Remote Optum Clinical Review jobs in Silver Spring, MD are:

What cities near Silver Spring, MD are hiring for Remote Optum Clinical Review jobs?

Cities near Silver Spring, MD with the most Remote Optum Clinical Review job openings:

Remote Optum Clinical Review jobs near you
Infographic showing various Remote Optum Clinical Review job openings in Silver Spring, MD as of August 2026, with employment types broken down into 57% Full Time, 32% Part Time, and 11% Contract. Highlights an 100% Remote job distribution, with an average salary of $74,434 per year, or $35.8 per hour.

Utilization Management Coordinator I

System One

Baltimore, MD • Remote

$24.67/hr

Contractor

Medical, Dental, Vision, Life, Retirement

Re-posted yesterday

Job description

Job Title: Utilization Management Coordinator I Type: Short-term contract (3 mos) Compensation: $24.67 Work Model: Remote – offsite. Must work east coast hours. Hours: 8 hours per day, 40 hours per week. 5 days on, 2 days off in a row. Training: Monday thru Friday the first month or so. After Training: Schedule will be either Tuesday thru Saturday – OR - Sunday thru Thursday.

Responsibilities

  • Support Utilization Management clinical teams by assisting with non-clinical administrative tasks related to pre-service, utilization review, care coordination, and quality of care
  • Perform member or provider related administrative support including benefit verification, authorization creation and management, claims inquiries, and case documentation
  • Review authorization requests for initial determination and triage for clinical review and resolution
  • Provide general support and coordination services for the department such as answering and responding to telephone calls, managing correspondence, researching information, and assisting in problem-solving
  • Assist with reporting, data tracking, gathering, organization, and dissemination of information such as Continuity of Care process and Peer to Peer reviews
Requirements
  • High School Diploma or equivalent
  • At least 1 to 3 years of experience in health care claims/service areas or office support
  • Two years of experience in health care/managed care setting or related work experience
  • Knowledge of CPT and ICD-10 coding
  • Effective communication, data entry, medical terminology, and medical knowledge skills
  • Ability to participate in multi-disciplinary teams and demonstrate excellent communication, organizational, and customer service skills
  • Knowledge of medical terminology and concepts in managed care
  • Proficient in standardized processes for evaluating medical support operations
  • Strong independent judgment and decision-making skills with tact and diplomacy
  • Attention to detail
  • Experienced with web-based technology and Microsoft Office applications including Word, Excel, and PowerPoint

System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

Ref: #851-Rockville-S1

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About System One

Sourced by ZipRecruiter

System One helps employers get work done more efficiently and economically without compromising quality. Over our 35+ year history, we've helped connect thousands of talented people with innovative companies. The excitement of a perfect fit motivates us every single day.

Industry

Business consulting services and recruiting and staffing services

Company size

5,001 - 10,000 Employees

Headquarters location

Pittsburgh, PA, US

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