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Remote Optum Utilization Review Jobs (NOW HIRING)

Dane Street, LLC

Utilization Review Physician

Perform utilization review for: * Preauthorization requests * Appeals (first and second level ... 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 ... This position is responsible for performing initial, concurrent review activities; discharge care ...

ERC Pathlight

Utilization Review Manager

Denver, CO · On-site +1

$93K - $117K/yr

Remote : Mondays and Fridays * On-site in our Denver Office: Tuesdays, Wednesdays, and Thursdays The compensation range for this position is based upon candidate experience and market expectations.

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 ...

VIVA USA INC

Utilization Review Nurse

Nashville, TN · On-site +1

$37.22 - $42.22/hr

... all Utilization Management activities to include review of inpatient and outpatient medical ... Remote Contract to Hire VIVA is an equal opportunity employer. All qualified applicants have an ...

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

As of Jun 6, 2026, the average hourly pay for remote optum 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 Utilization Review vs Remote UnitedHealthcare Utilization Review?

AspectRemote Optum Utilization ReviewRemote UnitedHealthcare Utilization Review
CredentialsLicenses in relevant states, certifications like CCM or CRC often preferredLicenses in relevant states, certifications like CCM or CRC often preferred
Work EnvironmentRemote, home-based with flexible hoursRemote, home-based with flexible hours
Employer & IndustryOptum, healthcare services and utilization managementUnitedHealthcare, health insurance and utilization review

Both roles involve reviewing healthcare claims and authorizations remotely, requiring similar credentials and work environments. The main difference lies in the employer and specific healthcare focus: Optum specializes in healthcare services and utilization management, while UnitedHealthcare focuses on health insurance and claims review. Candidates often compare these roles to determine the best fit based on employer and industry specialization.

How does a Remote Optum Utilization Review nurse typically collaborate with multidisciplinary teams while working from home?

As a Remote Optum Utilization Review nurse, collaboration with multidisciplinary teams is primarily conducted through secure digital platforms, including video calls, emails, and electronic health record systems. You’ll regularly communicate with physicians, social workers, case managers, and other healthcare providers to review patient cases, coordinate care plans, and ensure compliance with clinical guidelines. Despite working remotely, maintaining clear and timely communication is essential for effective patient advocacy and decision-making. Team meetings and case discussions are scheduled virtually, fostering a supportive environment and ensuring you stay connected to the broader healthcare team.

What is a Remote Optum Utilization Review position?

A Remote Optum Utilization Review position involves working for Optum, a healthcare services company, to evaluate medical records and determine the necessity and appropriateness of healthcare services. Employees in this role review clinical documentation to ensure that treatments meet established guidelines and help to manage healthcare costs while ensuring patient care is not compromised. The position is remote, meaning you can work from home or another location outside of a traditional office. Utilization review professionals often interact with healthcare providers, insurance companies, and patients, using their clinical expertise to make informed decisions.

What are the key skills and qualifications needed to thrive as a Remote Optum Utilization Review Nurse, and why are they important?

To thrive as a Remote Optum Utilization Review Nurse, you need a current RN license, strong clinical judgment, knowledge of utilization management, and experience in case review or discharge planning. Proficiency with medical review software, electronic health records, and familiarity with UM guidelines such as InterQual or Milliman is typically required. Exceptional communication, attention to detail, and critical thinking are vital soft skills for effective collaboration and decision-making in a remote environment. These skills ensure accurate assessments, regulatory compliance, and optimal patient outcomes while maintaining efficiency in a virtual workflow.
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Remote Optum Utilization Review jobs near you
Infographic showing various Remote Optum Utilization Review job openings in the United States as of May 2026, with employment types broken down into 100% Full Time. Highlights an 90% Physical, 1% Hybrid, and 9% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review Physician

Utilization Review Physician

Dane Street

Manhattan, NY • Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Overview We are seeking a high-performing Physician Reviewer to join our Group Health division. The role is responsible for delivering timely, defensible utilization review determinations across a high-volume, fast-paced environment. Reviews span multiple case types, including preauthorization, appeals, DRG clinical validation, benefit review, and experimental/investigational determinations.

Key Responsibilities Perform utilization review for: Preauthorization requests Appeals (first and second level) Independent external reviews DRG validation and clinical review Benefit and coverage determinations Experimental/Investigational (E/I) review Apply evidence-based criteria and guidelines, including: InterQual MCG CMS guidelines (including 2-Midnight Rule) LCD/NCD Client-specific policies Produce clear, concise, and defensible clinical rationales Maintain high accuracy and consistency across determinations Meet or exceed turnaround time (TAT) expectations, including urgent cases Participate in peer-to-peer discussions as needed Collaborate with QA and operational teams to ensure quality and compliance Reviews may be conducted within internal systems or client-specific platforms, depending on assignment and client requirements Performance Metrics High daily review volume with strong accuracy Consistent adherence to client-specific requirementsAbility to manage short-TAT and urgent cases efficiently Clear, audit-ready documentation Required Qualifications MD or DO, board-certified in Internal Medicine, Family Medicine, or similar Active, unrestricted medical license Prior utilization review experience, preferably in a health plan or IRO environment Familiarity with InterQual, MCG, and CMS guidelines Strong clinical judgment and documentation skills Ability to work independently in a high-throughput environment Technical Skills Proficiency with standard business tools (e.g., Google Workspace, Microsoft Office) Comfortable working across multiple systems, including internal platforms and client-specific portals Strong navigation and documentation skills within web-based applications Ability to manage multiple systems/screens simultaneously in a high-throughput environment Familiarity with Mac operating systems Work Environment Remote work from home Full-time, Monday–Friday Availability for occasional weekends and holiday coverage for urgent reviews Benefits Medical, dental, and vision coverage for you and your family Voluntary life insurance options for you, your spouse, and your children Other voluntary benefits: hospital indemnity, critical illness, accident indemnity, pet insurance plans Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost Generous paid time off policy 401(k) plan with company match Apple equipment and media stipend for remote workspace #J-18808-Ljbffr

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