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Remote Optum Utilization Review Jobs in Boca Raton, FL

NationsBenefits, LLC

Associate Account Manager

Plantation, FL · On-site +1

$122K - $127K/yr

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

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 ...

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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 Jun 16, 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 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.
Care Review Clinician - Remote in FL

Care Review Clinician - Remote in FL

Molina Healthcare

Miami Gardens, FL • Remote

$24 - $46.81/hr

Full-time

Posted 5 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 192 frontline employees who took The Breakroom Quiz

146th of 261 rated insurance

Job description

JOB DESCRIPTION

Must reside in Florida

Job Summary

Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. 

Essential Job Duties


• Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. 
• Analyzes clinical service requests from members or providers against evidence based clinical guidelines. 
• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. 
• Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. 
• Processes requests within required timelines. 
• Refers appropriate cases to medical directors (MDs) and presents cases in a consistent and efficient manner. 
• Requests additional information from members or providers as needed. 
• Makes appropriate referrals to other clinical programs. 
• Collaborates with multidisciplinary teams to promote the Molina care model. 
• Adheres to utilization management (UM) policies and procedures.

Required Qualifications

• At least 2 years health care experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. 
• Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. 
• Ability to prioritize and manage multiple deadlines.
• Excellent organizational, problem-solving and critical-thinking skills.
• Strong written and verbal communication skills.
•Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications


• Certified Professional in Healthcare Management (CPHM). 
• Recent hospital experience in a medical unit or emergency room. 

#PJHS2

#LI-AC1
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $24 - $46.81 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

What Molina Healthcare employees say

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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