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Remote Optum Health Utilization Review Jobs (NOW HIRING)

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Remote Utilization Review RN

Detroit, MI · Remote

$35 - $39/hr

Utilization Review RN Contract Duration: 12+ months Job Location: 100% REMOTE License Requirements ... Minimum 5 years of healthcare experience . * 3-5 years of Utilization Management experience ...

Slate Healthcare

RN - Utilization Review

Job Title In this remote role, you will perform utilization reviews, ensuring compliance with clinical guidelines and patient care standards. Collaborate with interdisciplinary teams to assess ...

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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 Sep 14, 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.

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Remote Optum Health Utilization Review jobs near you

Utilization Review Specialist

Remote

New Horizons of the Treasure Coast
Health Care and Social Assistance • 201 - 500 employees
Learn more about New Horizons of the Treasure Coastexternal

Full-time

Re-posted 10 days ago

Job description

New Horizons is the largest mental health and addiction recovery provider on the Treasure Coast (and beyond), serving 15,000 children and adults annually through inpatient crisis services, 24-hour help line and mobile response team, and outpatient programs conveniently located across Indian River, Martin, Okeechobee and St. Lucie counties. In addition, New Horizons assists 22,000 students in area schools, and we work closely with the courts, law enforcement, jails, and hospitals to help improve the health of individuals and the quality of life in our community.
New Horizons is seeking an Utilization Review Specialist, who will be responsible for following up on patient accounts when authorization for stay is required, initiate pre-certification timely via telephone or provider portal, review patients medical record via EMR to ensure criteria for the appropriate level of care is met, and provide clinical to insurance company to obtain authorization. This position is considered a Hybrid role.
As a Utilization Review Specialist, your responsibilities will include:
  • Follow each account during the IP stay and on discharge for authorization - document status in the electronic system,
  • Escalate any potential disputes or denial of accounts to Director of Revenue or designee
  • Trends disputed claims by payor
  • Obtain & follow authorization for Case Management Services
  • Adhere to federal, state, payer, and local regulations and accreditation requirements impacting case management scope of services
  • Adhere to department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation and agency policies

Requirements
REQUIRED:
  • High School diploma or equivalent required.
  • organizational skills,
  • verbal and written communication skills,
  • problem solving skills,
  • computer literacy.

Preferred:
  • Associate or Bachelor's degree preferred.
  • Paramedic, EMT or Nursing Assistant certification preferred.
  • Acute hospital experience preferred
  • Data Analytic skills preferred.

Apply