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Remote Optum Utilization Review Jobs in Indiana (NOW HIRING)

Astyra Corporation

Clinical Reviewer

Indianapolis, IN · Remote

$38 - $40/hr

Remote (U.S.-based) Licensure Requirement: Must hold an active clinical license in the State of ... of Utilization Review/Management (UR/UM) and/or Prior Authorization experience * 2+ years of ...

A.C. Coy

Cobol/IDMS Developer (Remote)

Indianapolis, IN · On-site +1

$48 - $65/hr

... and utilization of electronic data processing systems for product and commercial software ... Review project requests describing database users' needs to estimate time and cost required to ...

A.C. Coy

Cobol/IDMS Developer (Remote)

Indianapolis, IN · Remote

$48 - $65/hr

... and utilization of electronic data processing systems for product and commercial software ... Review project requests describing database users' needs to estimate time and cost required to ...

A.C. Coy

Cobol/IDMS Developer (Remote)

Indianapolis, IN · Remote

$48 - $65/hr

... and utilization of electronic data processing systems for product and commercial software ... Review project requests describing database users' needs to estimate time and cost required to ...

A.C. Coy

Cobol/IDMS Developer (Remote)

Indianapolis, IN · On-site +1

$48 - $65/hr

... and utilization of electronic data processing systems for product and commercial software ... Review project requests describing database user needs to estimate time and cost required to ...

A.C. Coy

Cobol/IDMS Developer (Remote)

Indianapolis, IN · Remote

$48 - $65/hr

... and utilization of electronic data processing systems for product and commercial software ... Review project requests describing database user needs to estimate time and cost required to ...

A.C. Coy

Cobol/IDMS Developer (Remote)

Indianapolis, IN · Remote

$48 - $65/hr

... and utilization of electronic data processing systems for product and commercial software ... Review project requests describing database user needs to estimate time and cost required to ...

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Remote Optum Utilization Review information

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.
What are the most commonly searched types of Optum Utilization Review jobs in Indiana? The most popular types of Optum Utilization Review jobs in Indiana are:
What are popular job titles related to Remote Optum Utilization Review jobs in Indiana? For Remote Optum Utilization Review jobs in Indiana, the most frequently searched job titles are:
What job categories do people searching Remote Optum Utilization Review jobs in Indiana look for? The top searched job categories for Remote Optum Utilization Review jobs in Indiana are:
What cities in Indiana are hiring for Remote Optum Utilization Review jobs? Cities in Indiana with the most Remote Optum Utilization Review job openings:
Remote Optum Utilization Review jobs near you
Infographic showing various Remote Optum Utilization Review job openings in Indiana as of July 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution.
Clinical Reviewer

Clinical Reviewer

Astyra Corporation

Indianapolis, IN • Remote

$38 - $40/hr

Full-time

Medical, Dental, Vision, Life, Retirement

Re-posted 12 days ago

Job description

Job Summary

The purpose of this position is to utilize clinical expertise to review medical records against established criteria in accordance with contract requirements.

Location: Remote (U.S.-based)
Licensure Requirement: Must hold an active clinical license in the State of Indiana or a Compact State license

Work Schedule:

  • 40 hours per week - Friday, Saturday, Sunday, and two weekdays
  • Weekend and/or holiday availability required 

Training Requirement:

  • Must be fully available to attend 100% of training. 
  • Schedule: Monday to Friday 9:00 AM – 6:00 PM EST
  • Duration: Minimum of 3 weeks
Key Responsibilities
  • Ensure accuracy and timeliness of all review cases in accordance with contract requirements
  • Manage daily workload and queues; adjust workflow as needed to meet departmental demands
  • Collaborate with Supervisor on quality monitoring and improvement activities
  • Maintain current knowledge of clinical practices and review processes
  • Serve as a liaison for providers regarding customer service issues and resolution
  • Perform various review types as assigned based on workload
  • Build and maintain professional relationships with internal and external stakeholders
  • Attend required trainings and team meetings
  • Cross-train to support business and client needs
  • Comply with all corporate policies, including HIPAA Privacy and Security regulations

Note: Responsibilities may evolve based on client needs.
 

Required Qualifications
  • Active, unrestricted LPN/LVN or RN license in Indiana or Compact State
  • Associate’s degree (Bachelor’s preferred) or diploma from an accredited nursing program
  • 2+ years of Utilization Review/Management (UR/UM) and/or Prior Authorization experience
  • 2+ years of medical necessity review experience
  • 1+ year of InterQual and/or Milliman Care Guidelines (MCG) experience
  • Strong knowledge of medical records, terminology, and disease processes
  • Excellent clinical assessment and critical thinking skills
  • Strong written and verbal communication skills
  • Ability to navigate multiple systems efficiently
  • Strong organizational skills and flexibility
Preferred Qualifications
  • 3+ years of clinical experience (acute care, behavioral health, and/or med-surgical)
  • Knowledge of NCQA and URAC standards
  • Experience working in a team-based environment
  • Proficiency in Microsoft Office
  • Strong time management and prioritization skills
  • Demonstrated ability to maintain confidentiality and ensure HIPAA compliance
Weekend and holiday flexibility is required
Proper email communication will only be done to and from @astyra.com email addresses. Please ensure you are communicating with approved Astyra recruiters by checking this point when receiving offers and messages from us. Please ensure you are communicating within these guidelines and proper channels for the quickest possible interview consideration!
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