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Remote Optum Utilization Review Jobs in Springfield, MO

Pharmacy Careers

Appeals Pharmacist (Remote)

Springfield, MO · On-site +1

$48.25 - $58.75/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 Springfield, MO salary details

$19

$38

$62

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

As of Jun 11, 2026, the average hourly pay for remote optum utilization review in Springfield, MO is $38.46, according to ZipRecruiter salary data. Most workers in this role earn between $30.38 and $44.18 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 the most commonly searched types of Optum Utilization Review jobs in Springfield, MO? The most popular types of Optum Utilization Review jobs in Springfield, MO are:
What are popular job titles related to Remote Optum Utilization Review jobs in Springfield, MO? For Remote Optum Utilization Review jobs in Springfield, MO, the most frequently searched job titles are:
What job categories do people searching Remote Optum Utilization Review jobs in Springfield, MO look for? The top searched job categories for Remote Optum Utilization Review jobs in Springfield, MO are:
What cities near Springfield, MO are hiring for Remote Optum Utilization Review jobs? Cities near Springfield, MO with the most Remote Optum Utilization Review job openings:
Remote Optum Utilization Review jobs near you

Drug Utilization Review Pharmacist

Pharmacy Careers

Springfield, MO • On-site, Remote

Other

Medical

Posted 20 days ago

Job description

Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications
A confidential managed care organization is seeking a skilled Drug Utilization Review (DUR) Pharmacist to support quality prescribing and improve patient outcomes. This role is ideal for pharmacists who enjoy analyzing medication use, applying clinical guidelines, and collaborating with providers to promote safe, cost-effective care.
Key Responsibilities

  • Conduct prospective, concurrent, and retrospective drug utilization reviews.
  • Evaluate prescribing patterns against clinical guidelines and formulary criteria.
  • Identify potential drug interactions, duplications, and inappropriate therapy.
  • Prepare recommendations for prescribers to optimize therapy and reduce risk.
  • Document reviews and ensure compliance with state, federal, and health plan requirements.
  • Contribute to quality improvement initiatives and pharmacy program development.


What You'll Bring

  • Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree.
  • Licensure: Active and unrestricted pharmacist license in the U.S.
  • Experience: Managed care, PBM, or health plan experience preferred - but hospital and retail pharmacists with strong clinical skills are encouraged to apply.
  • Skills: Analytical mindset, detail-oriented, and excellent written and verbal communication.


Why This Role?

  • Impact: Shape prescribing decisions that affect thousands of patients.
  • Growth: Build expertise in managed care and population health pharmacy.
  • Flexibility: Many DUR roles offer hybrid or fully remote schedules.
  • Rewards: Competitive salary, benefits, and career advancement opportunities.


About Us
We are a confidential healthcare partner providing managed care pharmacy services nationwide. Our DUR pharmacists play a key role in ensuring that medications are used safely, appropriately, and cost-effectively across diverse patient populations.
Apply Today
Advance your career in managed care pharmacy - apply now for our Drug Utilization Review Pharmacist opening and help lead the way in improving medication safety and outcomes.

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