ZipRecruiter

Log In

2

Remote Optum Utilization Review Jobs in Boca Raton, FL

Aspirion

Clinical Nurse Specialist

Delray Beach, FL · Remote

$68K - $100K/yr

Certification in Case Management or Utilization Review preferred Core expectations * Demonstrate ... US remote-based colleagues are not permitted to work from a location outside of the United States ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Hollywood, FL · On-site +1

$52.25 - $63.75/hr

Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

next page

Showing results 1-20

All JobsRemote Optum Utilization Review JobsRemote Optum Utilization Review Jobs in Boca Raton, FL

Remote Optum Utilization Review information

See Boca Raton, FL salary details

$20

$40

$65

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

As of Jul 6, 2026, the average hourly pay for remote optum utilization review in Boca Raton, FL is $40.12, according to ZipRecruiter salary data. Most workers in this role earn between $31.73 and $46.06 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 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 popular job titles related to Remote Optum Utilization Review jobs in Boca Raton, FL? For Remote Optum Utilization Review jobs in Boca Raton, FL, the most frequently searched job titles are:
What job categories do people searching Remote Optum Utilization Review jobs in Boca Raton, FL look for? The top searched job categories for Remote Optum Utilization Review jobs in Boca Raton, FL are:
What cities near Boca Raton, FL are hiring for Remote Optum Utilization Review jobs? Cities near Boca Raton, FL 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 Boca Raton, FL as of June 2026, with employment types broken down into 1% As Needed, 85% Full Time, 9% Part Time, 1% Temporary, and 4% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $83,458 per year, or $40.1 per hour.

Utilization Review Coordinator | Remote

Atlantic Health Strategies

Boca Raton, FL • On-site, Remote

$50K - $80K/yr

Full-time

Posted 6 days ago

Job description


About the Organization
Lotus Healthcare Billing is a behavioral health billing operation based in Boca Raton, Florida, supporting treatment programs through insurance authorization, utilization review, and payer communication. The team works closely with clinical staff to ensure that patients can access the levels of care they need, from detox through outpatient services.
The Opportunity
We are seeking a detail-oriented Utilization Review Coordinator to join the Lotus Healthcare Billing team. This full-time, remote role is well suited to someone who is organized, communicates clearly, and is comfortable managing a caseload where timelines directly affect patient care. A hybrid schedule with time in the Boca Raton office may be available for the right candidate. No prior utilization review experience is required. Training will be provided for the right candidate.
What You'll Do
  • Conduct daily phone contact with insurance companies to secure authorizations for behavioral health and substance use disorder treatment.
  • Manage a caseload of active authorizations, tracking timelines closely since they directly affect patient care.
  • Apply knowledge of SUD and behavioral health levels of care, including detox, residential, PHP, IOP, and outpatient, when communicating with payers.
  • Reference ASAM criteria and medical necessity standards to support authorization requests.
  • Use systems such as KIPU, Availity, or other payer portals to document and track review activity.
  • Communicate professionally and consistently with insurance representatives and internal clinical teams.
  • Work independently while staying aligned with program and compliance expectations.

Requirements
Requirements
  • High school diploma or equivalent required; associate's or bachelor's degree a plus.
  • Less than one year of relevant experience required; training provided for the right candidate.
  • Experience in utilization review, insurance authorization, or behavioral health billing preferred.
  • Familiarity with SUD/behavioral health levels of care (detox, residential, PHP, IOP, OP) is a strong plus.
  • Knowledge of ASAM criteria and medical necessity standards a plus.
  • Experience with KIPU, Availity, or payer portals preferred.
  • Strong organizational skills and attention to detail.
  • Clear, professional communication skills.
  • Comfortable working independently and managing a caseload.
  • Reliable home internet and a private, HIPAA-compliant workspace for remote work.

Benefits
Compensation and Schedule
  • Salary: $50,000 to $80,000 annually, commensurate with experience.
  • Schedule: Days, full-time, remote (hybrid option available for the right candidate).

This opportunity is posted by Atlantic Health Strategies on behalf of Lotus Healthcare Billing in Boca Raton, Florida.

Apply