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Remote Optum Utilization Review Jobs in Baton Rouge, LA

Imh

RN Care Manager - PRN

New Roads, LA · Remote

$41.20 - $62.17/hr

Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...

Imh

RN Care Manager

New Roads, LA · Remote

$41.20 - $62.17/hr

Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...

All JobsOptum Utilization Review JobsRemote Optum Utilization Review JobsRemote Optum Utilization Review Jobs in Baton Rouge, LA

Remote Optum Utilization Review information

See Baton Rouge, LA salary details

$20

$40

$66

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

As of Aug 10, 2026, the average hourly pay for remote optum utilization review in Baton Rouge, LA is $40.60, according to ZipRecruiter salary data. Most workers in this role earn between $32.07 and $46.63 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?

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 Baton Rouge, LA? The most popular types of Optum Utilization Review jobs in Baton Rouge, LA are:
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Remote Optum Utilization Review jobs near you
Infographic showing various Remote Optum Utilization Review job openings in Baton Rouge, LA as of August 2026, with employment types broken down into 100% Full Time. Highlights an 10% Hybrid, and 90% Remote job distribution, with an average salary of $84,449 per year, or $40.6 per hour.

Care Coordinator RN remote work: Baton Rouge or New Orleans

eQHealth Solutions

Baton Rouge, LA • Remote

Full-time

Re-posted yesterday

Job description

  • Performs care coordination services for assigned recipients who are eligible for home health services (Home Health Visits, PPEC, Personal Care Services and/or Private Duty Nursing Services etc. based on contract requirements).
  • Uses discretion to approve/validate UR or forward to 2nd level reviewer. Provides first level utilization review for all inpatient and outpatient services requiring authorization: Prospective Review Urgent/ Non-urgent, Concurrent Review and Retrospective Review.
  • Completes prior authorizations as appropriate in a timely manner.
  • Conducts an initial survey to recommend appropriate (home health assessment) for the recipient, unless this has already been done during the current fiscal year
  • Conducts a home and/or PPEC visit as needed or if contract requirement
  • Schedules and convenes initial face-to-face meeting in the recipient’s home and/or PPEC comprised of the recipient (if able) and the parent or legal guardian.
  • Assesses, plans, implements, monitors and evaluates the options and services required to meet the recipient’s health care needs.
  • Documents recipient’s assessment findings, actions, and outcomes.
  • Documents all communication, interventions and follow up tasks in the Care Coordination System within one (1) business day of each intervention and/or encounter.
  • Identifies patient care issues and makes recommendations on patient care issues.
  • Collaborates with the parent or legal guardian and healthcare team to arrange for identified home care needs.
  • Responsible for maintaining regular monthly contact (telephonically or face-to-face) with the recipient and the recipient’s parent or legal guardian.for purpose of updating Plan of Care (POC), resolving issues and identifying additional issues
  • As part of the multidisciplinary team, regularly meets with the team and contributes to the development of a comprehensive plan of care based on the needs of the recipient and recipient’s parent or legal guardian.
  • Evaluates and modifies recipient’s the plan of care as needed.  Regularly communicates changes to the recipient’s parent or legal guardian, healthcare team, and other agencies involved in the recipient’s care.
  • Monitors assigned caseload eligibility status on a monthly basis, based on their status in MMIS.
  • Completes a Staffing Tool (Freedom of Choice) any time a parent or legal guardian expresses the desire to reconsider a recipient’s placement into a Skilled Nursing Facility
  • Follow guidelines for additional required calls and visits for Skilled Nursing Facility (SNF) transitions to community settings for six (6) months.
  • Functions as a resource to the community.
  • Manages daily workload associated with quality review process, including facilitation of case assignments and follows up to ensure that all cases requiring additional assistance or care coordination are completed within timelines required by contract.
  •  Prioritizes and addresses requests and assignments in a professional manner to develop cooperative relationships to ensure that customer confidentiality is assured.
  • Provides courteous and prompt service to all internal and external customers at all times.
  • Attends staff meetings and continuing education sessions and will assist with learning opportunities as needed.
  • Participates in special projects, as needed.
  • Assists with the implementation of quality improvement initiatives.
  • Performs other duties as assigned.

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