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Remote Optum Utilization Review Jobs in Oregon (NOW HIRING)

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Remote Optum Utilization Review information

What is a Remote Optum Utilization Review?

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?

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.

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 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.

What are the most commonly searched types of Optum Utilization Review jobs in Oregon?

The most popular types of Optum Utilization Review jobs in Oregon are:

What cities in Oregon are hiring for Remote Optum Utilization Review jobs?

Cities in Oregon with the most Remote Optum Utilization Review job openings:

Full-Time Licensed Mental Health Counselor (LCSW, LMFT, LPC) - Remote

Clearly Heard Counseling Services, LLC

Newport, OR • Remote

Full-time

Medical, Dental, Vision, Life

Posted 19 hours ago

Posted today


Job description

Position Overview

Clearly Heard Counseling Services, LLC is seeking a dedicated and licensed mental health therapist to join our dynamic team as a Full-Time Licensed Mental Health Counselor. This role will specifically focus on providing high-quality mental health treatment to a diverse clientele from the comfort of a remote setting, with an emphasis on effective therapy and client support.

About the Organization

At Clearly Heard Counseling Services, we strive to improve access to mental health care by dismantling stigma and bridging gaps in care. Our organization is built on the foundation of fostering an inclusive culture where every client feels valued. We take pride in employing innovative treatment methodologies tailored to each patient’s individual needs, ensuring comprehensive mental health support.

Work Environment

This position offers the flexibility of remote work while also being integrated within an outpatient office setting. You will collaborate with a team of dedicated professionals who share a commitment to delivering the highest quality of clinical care. With an organizational culture that prioritizes collaboration and community engagement, you will have the opportunity to contribute to enriching the mental health landscape in Newport, Oregon.

Key Responsibilities
  • Be readily available to respond to family members or loved ones, returning all calls and emails within two hours during business hours and 24 hours at other times.
  • Communicate effectively with the Utilization Review and Business Departments regarding insurance authorizations and patient care billing, ensuring a clear flow of information.
  • Engage with referral sources and outpatient providers to ensure continuity of care throughout the patient’s treatment journey, confirming discharge appointments to facilitate seamless transitions.
  • Begin discharge planning on the day of admission for all patients, conducting discharge sessions to reinforce coping skills and ensure understanding of transition plans and resources.
  • Manage crises effectively in both therapy sessions and the treatment milieu, providing necessary support to both patients and staff while upholding clinical excellence.
  • Complete clinical documentation in a timely manner, with all notes entered at the time of service to maintain accurate patient records.
  • Establish therapeutic rapport with patients and their families, conducting thorough assessments for suicidality and potential hazards to self or others.
  • Facilitate admission assessments, treating all new patients with professionalism and a welcoming approach, while engaging in clinical outreach and program tours as needed.
  • Participate collaboratively in weekly treatment team meetings, contributing to the setting of treatment goals and providing additional clinical support as needed.
  • Conduct utilization reviews effectively with insurance providers, ensuring that clinical information is communicated to secure necessary authorizations.
Patient Population / Client Focus

Our clientele encompasses a diverse range of individuals seeking support for various mental health challenges. You will work closely with patients from different backgrounds and with varying needs, focusing on developing tailored treatment plans that consider each individual’s unique circumstances and goals. Your work will directly influence their recovery and overall wellbeing.

Qualifications
  • A Master’s or Doctorate degree in clinical psychology, counseling, or clinical social work (e.g., MA, MS, MSW, MFT, MHC, PhD, PsyD) from an accredited institution.
  • An active and independent mental health license in the state of Oregon (e.g., LCSW, LMFT, LPC).
  • Proven ability to manage a substantial caseload while effectively interfacing with large provider networks and support teams.
  • Proficiency in electronic medical records and solid written communication skills, particularly through email.
Preferred Experience
  • A demonstrated passion for enhancing lives within the behavioral health care sector.
  • Experience working in a variety of therapeutic settings, with knowledge of crisis management techniques.
  • Familiarity with documentation requirements and treatment planning methodologies relevant to outpatient mental health services.
Compensation and Benefits

The salary for this position is competitive and falls within the range of USD 80,000 – 100,000 per year, commensurate with experience. In addition to a fulfilling role within a supportive team, employees receive:

  • Professional liability insurance to protect against claims.
  • Access to an Employee Assistance Program for mental health support.
  • Minimal paperwork requirements, enabling you to focus more on patient care.
  • A full caseload that ensures a busy and rewarding work schedule.
  • Comprehensive benefits including medical, dental, and vision insurance.
  • Life and disability insurance options to provide additional security.
Career Growth Opportunities

At Clearly Heard Counseling Services, we believe in nurturing talent and professional growth. Employees are encouraged to pursue continuing education and training opportunities to enhance their skills and advance their careers. You will have the chance to work alongside experienced professionals, gaining insights and knowledge that can help propel your career in mental health.

Why Join Our Team

We are dedicated to building a diverse staff that reflects the communities we serve. Joining Clearly Heard Counseling Services means becoming part of a mission-driven organization that values each team member's contributions to mental health care. Your expertise and passion will be integral to reshaping perceptions of mental health while positively impacting the lives of your clients.

Application Information

If you are a licensed mental health therapist who is passionate about making a difference in the lives of others and looking to join a collaborative and innovative team, we would love to hear from you. Please submit your resume, cover letter, and any relevant credentials to us. We look forward to reviewing your application and exploring how you can contribute to our mission.