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Remote Optum Health Utilization Review Jobs (NOW HIRING)

Mindful Health

Utilization Review Specialist

$25 - $30/hr

Utilization Review Specialist Mindful Health is a fast-growing company with the goal of providing an intentionally different approach to mental health and well-being. We are a combination of bricks ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois ... We're on a mission to change health care -- an experience made whole by our unique backgrounds and ...

Dane Street, LLC

Utilization Review Physician

Overview We are seeking a high-performing Physician Reviewer to join our Group Health division. The ... Remote work from home * Full-time, Monday-Friday * Availability for occasional weekends and holiday ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson ... Health Care Insurance Company. * Knowledge of medical terminology and procedures. * Verbal and ...

Franciscan Health

Utilization Review Coordinator

Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care ... Perform concurrent reviews for appropriateness of utilization to optimize clinical and financial ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97457, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...

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Remote Optum Health Utilization Review information

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How much do remote optum health utilization review jobs pay per hour?

As of Jul 13, 2026, the average hourly pay for remote optum health utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is the difference between Remote Optum Health Utilization Review vs Remote UnitedHealth Group Utilization Review?

AspectRemote Optum Health Utilization ReviewRemote UnitedHealth Group Utilization Review
CertificationsTypically requires RN, LPN, or medical reviewer credentialsSimilar certifications, often RN or licensed healthcare professionals
Work EnvironmentRemote, healthcare insurance settingRemote, healthcare insurance setting
Employer & IndustryOptum, part of UnitedHealth Group, healthcare and insuranceUnitedHealth Group, healthcare and insurance
Job ResponsibilitiesReview medical necessity, authorizations, and claimsReview medical necessity, authorizations, and claims

Both roles involve remote medical review within the healthcare insurance industry, focusing on medical necessity and claims. The main difference lies in the specific employer, with Optum being a subsidiary of UnitedHealth Group. The certifications, work environment, and job responsibilities are very similar, making them comparable roles for healthcare professionals seeking remote utilization review positions.

What cities are hiring for Remote Optum Health Utilization Review jobs? Cities with the most Remote Optum Health Utilization Review job openings:
What are the most commonly searched types of Optum Health Utilization Review jobs? The most popular types of Optum Health Utilization Review jobs are:
What states have the most Remote Optum Health Utilization Review jobs? States with the most job openings for Remote Optum Health Utilization Review jobs include:
Remote Optum Health Utilization Review jobs near you

Utilization Review Specialist

Recovery Unplugged Florida

Fort Lauderdale, FL • On-site, Remote

$30K - $40K/yr

Other

Posted 5 days ago

Job description

Description

Utilization Review Specialist (Part-Time - Weekends) 


Location: Remote

Preferred Residence: Candidates residing in Florida, Tennessee, Texas, Virginia, South Carolina, or New Jersey are strongly encouraged to apply.


Job Details

Job Type: Part-Time

Schedule:

  • 16-24 hours per week
  • Weekend availability required
  • Ideal schedule is Friday through Monday, working 2-3 days within that timeframe
  • Schedule may vary based on business needs
About Recovery Unplugged

Recovery Unplugged is a national leader in drug and alcohol addiction treatment, offering an innovative, evidence-based approach that integrates the healing power of music into recovery. With treatment centers across Florida, Texas, Virginia, New Jersey, South Carolina, and Tennessee, we are committed to delivering compassionate care that helps individuals build lasting recovery.


Position Summary

Recovery Unplugged is seeking an experienced Utilization Review Specialist to join our team. This position plays a critical role in ensuring patients receive the appropriate level of care by obtaining and maintaining insurance authorizations, communicating with managed care organizations, and collaborating with clinical teams throughout the treatment process.

The ideal candidate has prior experience in behavioral health utilization review, understands managed care guidelines, and is comfortable advocating for patients with insurance providers.


Essential Responsibilities
  • Conduct utilization reviews for admissions and continued stays to establish medical necessity and obtain insurance authorizations.
  • Review clinical documentation to support the appropriate level of care and length of stay.
  • Present clinical information to insurance companies and managed care representatives to obtain or extend authorizations.
  • Communicate with insurance case managers regarding benefits, coverage, and authorization status.
  • Collaborate with clinical staff to ensure documentation meets payer requirements.
  • Provide guidance to treatment teams regarding insurance criteria, continued stay requirements, and discharge planning.
  • Maintain accurate, timely, and organized documentation in accordance with company policies and regulatory standards.
  • Work collaboratively with multidisciplinary teams to support quality patient care and reimbursement.
  • Protect patient confidentiality and comply with all HIPAA and organizational policies.
  • Perform other duties as assigned.

Compensation
  • $30,000-$40,000 annually, depending on experience, qualifications, and whether the selected candidate works a 2-day or 3-day weekend schedule.
  • Benefits may be available based on eligibility.

Join a team that's transforming addiction treatment through compassionate, evidence-based care and the healing power of music. If you're passionate about advocating for patients and navigating the utilization review process, we'd love to hear from you.


Recovery Unplugged is an Equal Opportunity Employer.


Requirements

  •  Previous experience in Utilization Review, Managed Care, Behavioral Health, or a related healthcare setting required.
  • Experience working with substance use disorder or behavioral health treatment programs is strongly preferred.
  • Strong knowledge of insurance authorization processes and reimbursement practices.
  • Excellent verbal and written communication skills.
  • Strong organizational skills with the ability to manage multiple cases simultaneously.
  • Proficiency with electronic medical records (EMR) systems and Microsoft Office.
  • Current clinical licensure is preferred but not required. Candidates with significant utilization review experience will be considered.

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