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Remote Optum Health Utilization Review Jobs in Raleigh, NC

Senture

Medical Director

Raleigh, NC · Remote

... health plan, or utilization management operation The Medical Director works collaboratively with organizational leadership, credentialing staff, peer reviewers, and regulatory stakeholders to ensure ...

Centene

Psychologist Reviewer

Durham, NC · On-site +1

$87K - $157K/yr

... health care. Why Join Us? * 100% remote flexibility * Meaningful work impacting care for youths ... Interact with network practitioners to provide education on best practice models and utilization ...

IQVIA

Director, Remote Research Clinicians

Durham, NC · Remote

... digital health, and operational management platforms. * Develop standards, metrics, reporting ... Review quality metrics, issue trends, audit findings, and operational performance indicators to ...

IQVIA

Director, Remote Research Clinicians

Durham, NC · Remote

... digital health, and operational management platforms. * Develop standards, metrics, reporting ... Review quality metrics, issue trends, audit findings, and operational performance indicators to ...

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All JobsOptum Health Utilization Review JobsRemote Optum Health Utilization Review JobsRemote Optum Health Utilization Review Jobs in Raleigh, NC

Remote Optum Health Utilization Review information

See Raleigh, NC salary details

$20

$41

$67

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

As of Sep 4, 2026, the average hourly pay for remote optum health utilization review in Raleigh, NC is $41.10, according to ZipRecruiter salary data. Most workers in this role earn between $32.50 and $47.21 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 are the most commonly searched types of Optum Health Utilization Review jobs in Raleigh, NC?

The most popular types of Optum Health Utilization Review jobs in Raleigh, NC are:

Remote Optum Health Utilization Review jobs near you
Infographic showing various Remote Optum Health Utilization Review job openings in Raleigh, NC as of July 2026, with employment types broken down into 90% Full Time, 5% Part Time, and 5% Contract. Highlights an 30% In-person, and 70% Remote job distribution, with an average salary of $85,491 per year, or $41.1 per hour.

Utilization Management Nurse

Brighton Health Plan Solutions, LLC

Chapel Hill, NC • Remote

Full-time

Re-posted 28 days ago

Job description

About The Role
BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely.
Primary Responsibilities
•    Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures.
•    Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments.
•    Collaborates with healthcare partners to ensure timely review of services and care.
•    Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed.
•    Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards
•    Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate.
•    Triages and prioritizes cases and other assigned duties to meet required turnaround times.
•    Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations.
•    Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements.
•    Duties as assigned.
Essential Qualifications
•    Current Licensed Practical Nurse (LPN) with state licensure. Must retain active and unrestricted licensure throughout employment.
•    Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
•    Must be able to work independently.
•    Must be detail oriented and have strong organizational and time management skills.
•    Adaptive to a high pace and changing environment- flexibility in assignment.
•    Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review.
•    Proficient in MCG and CMS criteria sets
•    Experience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or elective surgical cases preferred.
•    Working knowledge of URAC and NCQA.
•   2+ years’ experience in a UM team within managed care setting.
•   3+ years’ experience in clinical nurse setting preferred.
•   TPA Experience preferred.
 

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