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Remote Optum Utilization Review Jobs in Encinitas, CA

Accounting Manager

San Diego, CA · Remote

$105K - $130K/yr

San Diego, CA or Remote Compensation Range $105,000-$130,000 Position Summary We are looking for an ... Meet set annual billable utilization rate. * Meet set annual client retention rate. * Manage set ...

Business Systems Analyst

San Diego, CA · Remote

$70K - $100K/yr

Remote is not available. Responsibilities: Platform Administration & Governance * Enforce software ... Conduct periodic platform health reviews covering performance, license utilization, storage, and ...

Showing results 21-36

Remote Optum Utilization Review information

See Encinitas, CA salary details

$22

$45

$74

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

As of Sep 6, 2026, the average hourly pay for remote optum utilization review in Encinitas, CA is $45.41, according to ZipRecruiter salary data. Most workers in this role earn between $35.87 and $52.16 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 Encinitas, CA?

For Remote Optum Utilization Review jobs in Encinitas, CA, the most frequently searched job titles are:

What cities near Encinitas, CA are hiring for Remote Optum Utilization Review jobs?

Cities near Encinitas, CA with the most Remote Optum Utilization Review job openings:

Clinical Account Representative, CardioMEMS - Riverside, CA

Abbott

San Diego, CA • Remote

Full-time

Medical, Retirement, PTO

Re-posted 25 days ago


Key responsibilities

  • Support the growth of CardioMEMS by driving utilization, supporting key accounts, and delivering education and technical support.

  • Serve as the primary point of contact for high-volume, established accounts, ensuring seamless onboarding and patient monitoring workflows.

  • Provide technical troubleshooting, clinical support, and training to clinical staff and account stakeholders.


Abbott rating

7.8

Company rating: 7.8 out of 10

Based on 138 frontline employees who took The Breakroom Quiz

170th of 545 rated manufacturers


Job description

Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 115,000 colleagues serve people in more than 160 countries.JOB DESCRIPTION:
Job Title

Clinical Account Representative, CardioMEMS - San Diego, CA

Working at Abbott

At Abbott, you can do work that matters, grow, and learn, care for yourself and family, be your true self and live a full life. You'll also have access to:

  • Career development with an international company where you can grow the career you dream of.

  • Employees can qualify for free medical coverage in our Health Investment Plan (HIP) PPO medical plan in the next calendar year

  • An excellent retirement savings plan with high employer contribution

  • Tuition reimbursement, the Freedom 2 Save student debt program and FreeU education benefit - an affordable and convenient path to getting a bachelor's degree.

  • A company recognized as a great place to work in dozens of countries around the world and named one of the most admired companies in the world by Fortune.

  • A company that is recognized as one of the best big companies to work for as well as a best place to work for diversity, working mothers, female executives, and scientists.

Heart Failure

In Abbott's Heart Failure (HF) business, we're developing solutions to diagnose, monitor and manage heart failure, allowing people to restore their health and get on with their lives.

The Clinical Account Representative (CAR) supports the growth of CardioMEMS by driving utilization, supporting key accounts, and delivering education and technical support. This is a sales-forward role focused on account development, workflow optimization, and expanding access to the therapy. The CAR operates at the intersection of clinical expertise, relationship management, and commercial execution, ensuring that CardioMEMS is successfully integrated into heart failure care pathways and delivers measurable patient and economic value.

The ideal candidate would be based in the Riverside area, with travel to San Diego and Orange County.

WHAT YOU'LL DO

1. Sales & Customer Engagement

  • Serve as the primary point of contact for highvolume, established accounts, ensuring seamless onboarding and patient monitoring workflows.

  • Achieve assigned sales and utilization targets within defined accounts.

  • Execute actionable quarterly business plans with clear activity goals and growth drivers.

  • Conduct routine account checkins to review program performance, identify barriers, and uncover new opportunities.

  • Deliver product demonstrations and participate in educational meetings to drive adoption and expand utilization.

  • Provide competitive insights, including customer feedback and market intelligence.

  • Provide coverage for Territory Managers during PTO, meetings, and peak demand periods.

2. Account Management

  • Maintain CRM documentation for key accounts, including activity notes, opportunities, and followups.

  • Build and sustain strong relationships with physicians, APPs, HF clinics, and administrators.

  • Conduct quarterly account reviews in collaboration with Territory Manager to support program health, patient volume trends, and operational needs.

  • Support the execution of workflow optimizations to improve patient identification, onboarding, and monitoring processes.

3. Technical & Clinical Support

  • Provide technical troubleshooting for remote monitoring issues and workflow challenges, escalating as needed.

  • Offer procedural case support occasionally for broader territory, focusing on priority accounts.

  • Support training and education for new clinical staff, HF clinics, and administrators.

  • Participate in product inservices and support clinical data collection as needed.

  • Continue developing strong product, HF, and CardioMEMS competency.

4. Compliance & Collaboration

  • Adhere to all FDA, regulatory, and company quality requirements.

  • Maintain accurate documentation of sales activities, account plans, expenses, and clinical interactions.

  • Collaborate effectively with Territory Managers, Marketing, Professional Education, Clinical Specialists, and sales leadership.

  • Maintain professional, compliant, and positive communication with all hospital and internal stakeholders.

EDUCATION AND EXPERIENCE YOU'LL BRING

Required

  • Bachelor's degree (Business, Life Sciences, Engineering, or related).

  • Experience: 2-4 years in medical device or healthcare (inside or field).

  • Demonstrates consultative selling skills, including uncovering needs, asking strategic questions, and positioning solutions that drive utilization growth.

  • Track record of 100% to goal in the most recent performance year.

  • Account-facing experience with clinicians and administrators (e.g., HF clinics, service line leaders).

  • Proficiency with CRM (Salesforce preferred), Excel/analytics, and PowerPoint.

  • Comfortable delivering clinical/technical presentations to audiences of 10-50 stakeholders.

Preferred

  • Knowledge of reimbursement landscape and payment pathways (highly preferred).

  • Experience at top MedTech organizations (highly preferred).

  • 1-2 years of commercial experience.

  • Experience in Cardiology/HF/EP/Structural Heart or remote monitoring.

  • Prior involvement in value analysis or committeebased selling.

  • Familiarity with Cath lab/OR workflows; basic procedural support experience.

Apply Now

Learn more about our health and wellness benefits, which provide the security to help you and your family live full lives: www.abbottbenefits.com

Follow your career aspirations to Abbott for diverse opportunities with a company that can help you build your future and live your best life. Abbott is an Equal Opportunity Employer, committed to employee diversity.

Connect with us at www.abbott.com, on Facebook at www.facebook.com/Abbott, and on Twitter @AbbottNews.

The base pay for this position is

$68,000.00 - $136,000.00

In specific locations, the pay range may vary from the range posted.

JOB FAMILY:Support ServicesDIVISION:HF Heart FailureLOCATION:United States > California : RemoteADDITIONAL LOCATIONS:WORK SHIFT:StandardTRAVEL:Yes, 25 % of the TimeMEDICAL SURVEILLANCE:Not ApplicableSIGNIFICANT WORK ACTIVITIES:Continuous standing for prolonged periods (more than 2 consecutive hours in an 8 hour day), Continuous walking for prolonged periods (more than 2 hours at a time in an 8 hour day), Driving a personal auto or company car or truck, or a powered piece of material handling equipmentAbbott is an Equal Opportunity Employer of Minorities/Women/Individuals with Disabilities/Protected Veterans.EEO is the Law link - English: http://webstorage.abbott.com/common/External/EEO_English.pdfEEO is the Law link - Espanol: http://webstorage.abbott.com/common/External/EEO_Spanish.pdf

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