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Remote Optum Utilization Review Jobs in Boca Raton, FL

NRG MGMT LLC

Collections Specialist

Lake Worth, FL · On-site +1

$16.50 - $22.25/hr

... utilization review, and insurance verification for substance abuse and mental health treatment ... Work Environment Office or remote work environment, depending on company policy. Fast-paced ...

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All JobsOptum Utilization Review 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 Sep 11, 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 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 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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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.

Certified Coder & Auditing (TEXAS BASED ONLY - MUST RESIDE)

West Palm Beach, FL • Remote

Dane Street, LLC
Insurance Actuarial and Claim Adjusting Services • 51 - 200 employees
Learn more about Dane Street, LLCexternal

$23 - $31.50/hr

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 10 days ago

Job description

MUST RESIDE IN TEXAS AND HAVE CODING AND AUDITING EXPERIENCE. Counter Affidavit as well as Testimony experience is preferred.

Requirements

We are seeking an experienced CPC certified medical coder to perform coding audits, utilization reviews, audits and more. We are looking for someone who can provide litigation support including deposition and testimony services when needed. The ideal candidate must have strong Texas based coding experience and a thorough understanding of medical necessity, documentation compliance, and payer audit defense. Counter Affidavit experience is preferred.

Responsibilities:

• Perform detailed medical coding audits (ICD-10-CM, CPT, HCPCS)

• Conduct utilization reviews to determine medical necessity and documentation compliance

• Review and prepare demand packages and audit response materials

• Analyze records for payer disputes and recoupments

• Prepare written audit findings and defensible reports

• Provide expert support for depositions and testimony as needed

• Review E/M services under 2021+ guidelines

• Interpret CMS, LCD/NCD, and payer-specific policies

• Identify risk areas and compliance vulnerabilities

Required Qualifications:

• Active CPC certification through the American Academy of Professional Coders (AAPC)

• CPMA preferred

• Minimum 5 years of professional coding experience

• At least 3 years of Texas-based coding experience required

• Strong knowledge of Texas Medicaid (TMHP) and Texas commercial payer policies

• Prior audit and utilization review experience required

• Experience supporting legal cases, depositions, or expert testimony strongly preferred

• Excellent written documentation and reporting skills

• Ability to work independently and meet deadlines

This position may be part-time depending on the candidate's qualifications. Texas residency is a requirement.

Benefits

Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace. 

ABOUT DANE STREET:

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.