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Remote Optum Utilization Review Jobs in Boca Raton, FL

Lakeview Loan Servicing

Sr. Benefits Analyst

Fort Lauderdale, FL · Remote

$95K - $120K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

This is a fully remote position that offers a competitive salary range of $95,000 to $120,000, plus ... Prepare and review required US filings and disclosures (e.g., Form 5500, SPD, SAR, 1095-Cs) and ...

NationsBenefits, LLC

Associate Account Manager

Plantation, FL · On-site +1

$122K - $127K/yr

  • Medical

Open to remote & onsite/hybrid in Plantation, FL Primary Responsibilities: 1. Client Account ... utilization. * Prepare and present Monthly Reports, Quarterly Business Reviews (QBRs), and ad hoc ...

NationsBenefits

Associate Account Manager

Plantation, FL · On-site +1

$122K - $127K/yr

  • Medical

Open to remote & onsite/hybrid in Plantation, FL Primary Responsibilities: 1. Client Account ... utilization. * Prepare and present Monthly Reports, Quarterly Business Reviews (QBRs), and ad hoc ...

NationsBenefits

Account Manager

Plantation, FL · On-site +1

  • Medical

Open to remote & onsite in Plantation, FL Primary Responsibilities: 1. Client Account Management ... utilization. * Prepare and present Monthly Reports, Quarterly Business Reviews (QBRs), and ad hoc ...

NationsBenefits, LLC

Account Manager

Plantation, FL · On-site +1

  • Medical

Open to remote & onsite in Plantation, FL Primary Responsibilities: 1. Client Account Management ... utilization. * Prepare and present Monthly Reports, Quarterly Business Reviews (QBRs), and ad hoc ...

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Showing results 21-40

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 Aug 19, 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:

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.

Manager, Clinical Appeals

Health Business Solutions LLC

Cooper City, FL • Remote

Full-time

Re-posted 6 days ago

Job description

Job Summary:

We are seeking an experienced and highly organized Manager of Clinical Appeals to lead our clinical appeals operations across commercial and government payers. This role is responsible for overseeing day-to-day activities of clinical appeal specialists, managing appeal strategy execution, ensuring quality and compliance, and meeting client-specific performance goals.

The ideal candidate brings a strong background in clinical review, medical necessity denials, payer appeal processes, and team leadership—ideally across both U.S. and offshore teams (e.g., Philippines). This position is critical to ensuring timely and effective resolution of denied claims, supporting revenue recovery efforts, and maintaining payer and regulatory compliance.

Key Responsibilities:

  • Manage the full-cycle clinical appeals process across multiple payer types, with a focus on government (e.g., Medicare, Medicaid) and commercial payers.
  • Lead and support a team of nurses, clinical reviewers, and appeal specialists—including potential offshore (Philippines-based) staff.
  • Monitor appeal workloads, productivity, and turnaround times to ensure all appeal deadlines and client service level agreements (SLAs) are met.
  • Review and approve complex or high-value clinical appeal cases, ensuring clinical accuracy and compliance with payer guidelines.
  • Maintain up-to-date knowledge of medical necessity criteria, payer policies, NCDs/LCDs, and applicable CMS regulations.
  • Train new and existing team members on clinical guidelines, appeal writing standards, and regulatory requirements.
  • Work cross-functionally with audit, legal, compliance, and operations teams to align on strategy and escalate trends or systemic payer issues.
  • Identify and implement process improvements to increase efficiency, reduce denials, and improve overturn rates.
  • Support the creation and refinement of appeal templates, clinical arguments, and documentation standards.
  • Generate and deliver performance and quality reports to leadership, identifying risks and opportunities for improvement.

Qualifications:

  • Registered Nurse (RN) or clinical degree required; Bachelor's degree in Nursing, Health Administration, or related field preferred.
  • 5+ years of experience in clinical appeals, utilization review, or medical necessity denials.
  • 2+ years in a leadership or supervisory role, preferably within a revenue cycle or payer appeals setting.
  • In-depth understanding of payer denial processes, especially Medicare Advantage, Medicaid Managed Care, and commercial plans.
  • Experience managing remote and/or offshore teams (Philippines experience preferred).
  • Strong working knowledge of ICD-10, CPT, and HCPCS coding as they relate to clinical justifications.
  • Excellent writing skills and the ability to clearly communicate complex clinical reasoning.
  • Familiarity with appeal submission portals, EHRs, and workflow platforms.
  • Knowledge of HIPAA, CMS, and NCQA standards.

Apply