ZipRecruiter

Log In

2

Remote Optum Utilization Review Jobs in Washington

Koniag, Inc.

FinOps Specialist (REMOTE)

Washington, DC · On-site +1

... variances, utilization, forecast changes, material issues, and risks. * Monitor cloud budgets ... for review and disposition. * Participate in Agile or program-management ceremonies, including ...

kgs

FinOps Specialist (REMOTE)

Washington, DC · Remote

... variances, utilization, forecast changes, material issues, and risks. * Monitor cloud budgets ... for review and disposition. * Participate in Agile or program-management ceremonies, including ...

kgs

FinOps Specialist (REMOTE)

Washington, DC · Remote

... variances, utilization, forecast changes, material issues, and risks. * Monitor cloud budgets ... for review and disposition. * Participate in Agile or program-management ceremonies, including ...

Ignite IT

Senior Network Security Engineer

Suitland, MD · Remote

$63 - $82.50/hr

... reviews, recertification, cleanup, and decommissioning. * Install, configure, maintain, patch ... remote users, certificates, authentication policies, availability, utilization, and user access ...

Bcbsa

Director, Trade Client Relations

Gaithersburg, MD · Remote

$155K - $175K/yr

Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy ... Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed

AvantGarde, LLC

Program Manager

Washington, DC · On-site +1

Remote work options are available after a brief acclimation period. Essential Duties and ... reviews, and governance audits to identify risks, trends, and opportunities for improvement. · ...

AvantGarde, LLC

Program Manager

Washington, DC · On-site +1

Remote work options are available after a brief acclimation period. Essential Duties and ... reviews, and governance audits to identify risks, trends, and opportunities for improvement. · ...

SAIC

Principal Ground Systems Integrator

Chantilly, VA · On-site +1

$120K - $160K/yr

TS/SCI Potential for Remote Work: ORA_ON_SITE Description SAIC is seeking experienced Principal ... Support readiness reviews and major program reviews to evaluate ground system readiness.

previous pagenext page

Showing results 21-40

All JobsOptum Utilization Review JobsRemote Optum Utilization Review JobsRemote Optum Utilization Review Jobs in Washington

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?

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.

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

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

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

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

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

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

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

Cities in Washington 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 Washington as of August 2026, with employment types broken down into 75% Full Time, 15% Part Time, and 10% Contract. Highlights an 100% Remote job distribution.

Lead Researcher & SME - Forced Labor and Human Trafficking in Supply Chains

McColm and Company

Arlington, VA • On-site, Remote

$192K/yr

Contractor

This job post has expired today. Applications are no longer accepted.

Job description

Position: Lead Researcher and Subject Matter Expert (SME)
Engagement Type: Short Term Consultancy
Location: Fully Remote
McColm & Company (McColm) is a mission-driven and customer-focused professional services firm that equips change makers with the knowledge, skills, and insights they need to succeed in an increasingly complex world. McColm specializes in supporting U.S. federal customers with national security, human services, foreign affairs, and emergency response-focused portfolios by managing bespoke professional training programs, delivering effective capacity building solutions, and providing highly specialized technical assistance and analysis expertise to decision makers.
McColm's Justice and Resilience Practice supports U.S. Government clients working to identify and mitigate forced labor and human trafficking risks globally. McColm seeks a subject matter expert to serve as the Lead Researcher and Subject Matter Expert (SME) for a Strategic Assessment and Gap Analysis project related to force labor and human trafficking in global supply chains.
The Lead Researcher will serve as the methodological lead for this project and is the principal author of study. The project combines structured stakeholder interviews and focus groups, stakeholder surveys, document and policy review, analysis of utilization data, and comparative benchmarking. Findings are triangulated across data sources to characterize operational, technical, policy, content, and capability gaps, and to inform prioritized, evidence-based recommendations on future-state operating, governance, and funding models.
The position is fully remote and requires virtual meetings and briefings with government personnel and stakeholders. The Lead Researcher coordinates closely with the U.S. Government client, a Senior Project Director, a supporting Investigator/SME, and lived experience expert reviewers.
This position is classed as a 1099 Independent Contractor.
Duties
The responsibilities of the Lead Researcher and SME include, but are not necessarily limited to, the following duties:
  • Serve as lead researcher and methodological lead for the assessment, drafting the methodology and tool development, including stakeholder mapping, sampling strategy, interview and focus group protocols, survey instruments, and the analytic framework.
  • Design and lead all data collection activities, including structured stakeholder interviews and focus groups, stakeholder surveys, document and policy review, and analysis of utilization data.
  • Lead comparative benchmarking analysis.
  • Triangulate qualitative and quantitative findings across data sources; identify operational, technical, policy, content, and capability gaps; and characterize evidence limitations and confidence levels with methodological transparency.
  • Draft substantive sections of the Draft and Final Strategic Assessment and Gap Analysis Reports, including current-state, governance, and sustainability assessments; utilization and comparative value findings; benchmarking observations; gap, risk, and maturity analysis; and future-state operating, governance, and funding options.
  • Coordinate closely with the Senior Project Director, a supporting Investigator/SME, and network consultant reviewers, and participate in periodic virtual meetings with government personnel and stakeholders.

Requirements
  • Advanced degree (Master's or higher preferred) in public policy, international relations, human rights, law, economics, social science research, or a related field, or equivalent professional experience.
  • Demonstrated subject matter expertise in responsible sourcing, supply chain due diligence, forced labor risk mitigation, and/or anti-trafficking policy, including familiarity with federal anti-trafficking procurement requirements.
  • Proven experience leading mixed-methods research or evaluations, including design of sampling strategies, interview and focus group protocols, and survey instruments, and triangulation of qualitative and quantitative data.
  • Experience conducting program assessments, evaluations, gap analyses, or strategic reviews for U.S. Government clients or comparable institutional clients.
  • Prior experience supporting U.S. Government clients through research.
  • Strong analytical writing skills, with demonstrated ability to produce evidence-based reports and actionable recommendations for senior government decision-makers.
  • Excellent stakeholder engagement and facilitation skills, including experience interviewing government, private sector, and lived experience stakeholders.
  • Experience applying trauma-informed and survivor-centered approaches in the overall research approach and when engaging with lived experience expert reviewers and stakeholders.
  • Experience with benchmarking or comparative analysis of digital tools or platforms, including governance, sustainability, and funding model assessment.
  • Strong experience using AI tools for data analysis.
  • Ability to work independently in a remote environment and manage competing deadlines across a phased workplan.

Benefits
Compensation is offered according to job requirements, market dynamics, and experience/skills of the successful candidate. Contract and consultant roles are not eligible for benefits.
We are an equal opportunity employer offering employment without regard to race, color, religion, sex, age, sexual orientation, national origin, citizenship, gender identity or expression, disability status, or any other characteristic protected by federal, state or local laws.
Due to the high volume of applications McColm receives and to ensure we comply with our internal hiring policies, we regret we are not able to respond to individual phone calls or emails regarding submission status.

Apply