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Remote Optum Utilization Review Jobs in Tennessee

Revecore

Nurse Consultant

Franklin, TN · Remote

Remote-USA The Role: Denial Prevention Nurse Consultant Primarily responsible for thorough review ... Minimum 5 years of related experience and/or training in utilization review or patient accounting

Surgery Partners

Biller - Remote

Brentwood, TN · On-site +1

$17.75 - $22.75/hr

SKILLS: • Skills in gathering and reporting claim information. • Skills in solving utilization ... For further information, please review the Know Your Rights notice from the Department of Labor.

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Charlie Health

Patient Finance Specialist

Nashville, TN · Remote

$17.50 - $23.25/hr

... Billing, Utilization Review, Outreach and Clinical * Support client-related requests from the ... LI-Remote Based on the nature of this role, you will need to complete several state background ...

VIVA USA INC

Nurse Case Manager

Nashville, TN · On-site +1

... utilization management to members. Performs prospective, concurrent, and retrospective reviews for ... Remote in any state except, NY, CA, HI and AK VIVA is an equal opportunity employer. All qualified ...

VIVA USA INC

Nurse Case Manager

Nashville, TN · On-site +1

remote in any state except, NY, CA, HI and AK Description: Nurse Case Management Senior Analyst ... utilization management to members. Performs prospective, concurrent, and retrospective reviews for ...

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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 Tennessee?

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

What are popular job titles related to Remote Optum Utilization Review jobs in Tennessee?

For Remote Optum Utilization Review jobs in Tennessee, the most frequently searched job titles are:

What job categories do people searching Remote Optum Utilization Review jobs in Tennessee look for?

The top searched job categories for Remote Optum Utilization Review jobs in Tennessee are:

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

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

Remote Optum Utilization Review jobs near you

Clinical Consulting Pharmacist - Remote (must reside in PA or TN)

StateServ Medical LLC

Memphis, TN • Remote

$55.28 - $57.69/hr

Full-time

Re-posted 6 days ago

Job description

Dragonfly Health - A great place to land

Dragonfly Health is the leading care-at-home data, technology and service platform, and the industry’s first scale durable medical equipment (DME) and pharmacy solution. Built on a 20-year history, Dragonfly Health uses advanced technology and robust analytics to manage DME and pharmaceutical services as part of a single, efficient solution for caregivers, patients, and their families. We serve over 145,000 patients every day in all 50 states.

Here, you are an integral part of a team that is transforming the future of hospice and post-acute healthcare. This is where innovation, collaboration and compassion thrive, allowing us to carry out our work at the highest level to serve our patients at a time in their life when they need us most.

We offer a dynamic and inclusive workplace where you'll have the unique opportunity to shape the future of healthcare alongside a passionate and talented team. We believe in empowering our employees to grow both personally and professionally, providing ample opportunities for career advancement, continuous learning, and skill development.

Dragonfly Health is our name for a reason.

The dragonfly is symbolic of the transformational impact we’re making on the industry, our people, and the lives we touch. We are a guiding force for what’s ahead, delivering more than equipment and medications, but also comfort and peace of mind. We are agile and adaptable, able to quickly and easily pivot from one point to the next, ready for whatever situation or patient need that arises.

Whatever it takes. Wherever it takes us. What we offer
  • Competitive Pay $55.28-57.69/hour + $5,000 sign-on bonus with shift differential (12% 6PM to 12:00AM and 15% 12:01AM-6AM)
  • Comprehensive Benefits Package (Health, Dental, Vision, PTO, Sick Time, 401k w/match, etc.)
  • Growth Opportunity and Career Advancement
  • Agile and Adaptable team culture
  • Innovative and revolutionary technology solutions
  • A higher calling to provide quality patient care

See how Dragonfly Health is transforming the world of hospice and post-acute care.

What you will do
  • Provide clinical review and consultation on medication requests, prior authorizations, and benefit determinations.
  • Evaluate therapy appropriateness, dosing, and safety based on evidence-based guidelines.
  • Collaborate with providers to clarify prescriptions and recommend alternatives when appropriate.
  • Support complex case reviews and appeals with accurate clinical documentation.
  • Identify opportunities to improve medication adherence, safety, and cost-effectiveness.
  • Educate internal teams on formulary management, utilization review, and pharmacy policy updates.
What we look for
  • R.Ph required; PharmD preferred
  • Full, current, and unrestricted pharmacist license in PA, TN
  • Ability to obtain additional state licensure based on business needs
  • 1+ year of pharmacy experience preferred (retail, hospital, or managed care)
  • Working knowledge of formulary management, clinical guidelines, and pharmacy benefit structures
  • Strong communication, analytical, and consultative skills
  • Ability to exercise sound clinical judgment and work independently
  • Commitment to evidence-based practice and continuous learning
Why Clinical Consulting Pharmacists are important

Every medication decision we make affects someone’s health, safety, and quality of life. As a Clinical Consulting Pharmacist, you ensure our members receive clinically appropriate, cost-effective therapies — helping balance patient care with responsible resource management. Your expertise directly advances our mission of improving health outcomes through compassionate, evidence-based pharmacy care.

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