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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 ...

Aspirion

Clinical Nurse Specialist

Delray Beach, FL · Remote

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 ...

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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 Jun 10, 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:
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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 8% As Needed, 88% Full Time, and 4% Nights. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $83,458 per year, or $40.1 per hour.

Utilization Review Specialist

Cutting Edge Staffing LLC

Pompano Beach, FL • Remote

Full-time

Posted 4 days ago

Job description

Exciting Opportunity with Banyan Treatment Centers!

We are seeking a Utilization Review Specialist to join our corporate team in Pompano Beach, FL. The position is responsible for contacting external case managers and managed care organizations for pre-authorization and concurrent reviews for the duration of a patient’s treatment stay. They also establish and maintain contracts with managed care companies and requests rate increases when deemed appropriate.

Position Details:
  • Reports To: Director of Utilization Review
  • Schedule: Full-Time, Weekdays (Weekend availability as needed).
  • Location: Remote
Key Responsibilities:

  • Manage a caseload of 50–75 patients and authorize 15–25 cases daily, ensuring timely utilization reviews and appropriate level of care.

  • Verify insurance benefits, coordinate authorizations, and communicate effectively with managed care providers.

  • Conduct admission and continuing-stay reviews to assess medical necessity and ensure compliance with treatment standards.

  • Collaborate with clinical and billing departments to support discharge planning, documentation, and timely reimbursement.

  • Identify and address over/underutilization trends and assist in resolving outstanding case issues with insurers.

Requirements:
  • High School diploma or equivalent; graduate degree in a health or behavioral health related field preferred.
  • Minimum of one-year experience working in a utilization review position (psychiatric or chemical dependency).
    Why Join Banyan Treatment Centers?

    This is more than a job, it’s a chance to be a vital part of what recovery looks like after treatment. As a Utilization Review Specialist, you’ll help ensure that each client leaves treatment with a clear plan, strong connections, and the resources they need to continue their recovery journey with confidence.

    • Join a Mission-Driven, Nationally Recognized Organization: We’re accredited by the Joint Commission and backed by TPG’s Rise Fund, with 18 locations and Telehealth services nationwide.
    • Champion the Continuum of Care: Be a key player in ensuring clients transition successfully from treatment into long-term recovery supports.
    • Work in Partnership: Collaborate with clinical, operational, and business development teams, as well as families and external partners, to make sure no detail is missed.
    • Enjoy Comprehensive Benefits: Including medical, vision, and dental insurance; whole and term life insurance; short- and long-term disability coverage; 401(k) with employer match; paid time off and holidays; and wellness, assistance, and referral programs.
    Apply Now!

    If you're passionate about building bridges to lasting recovery and ensuring every patient has a plan beyond our doors, apply today and help us continue making a difference at Banyan Treatment Centers.

    We are an Equal Opportunity Employer and welcome applicants of all backgrounds. We encourage veterans, active-duty military, and first responders to apply in support of our First Responders Program.