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

As of Jun 30, 2026, the average hourly pay for weekday optum utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is the difference between Weekday Optum Utilization Review vs Weekday Optum Claims Reviewer?

AspectWeekday Optum Utilization ReviewWeekday Optum Claims Reviewer
Primary RoleAssess medical necessity and appropriateness of healthcare servicesReview and process insurance claims for accuracy and compliance
CredentialsTypically requires nursing or healthcare-related certificationsUsually requires insurance or claims processing experience, with some certifications preferred
Work EnvironmentOffice-based, healthcare settings, remote optionsOffice or remote, insurance company environment
Industry UsageHealthcare insurance, utilization managementInsurance claims processing, customer service

While both roles are integral to healthcare insurance operations, Weekday Optum Utilization Review focuses on evaluating the medical necessity of services, whereas Weekday Optum Claims Reviewer handles claims processing and verification. Understanding these differences helps job seekers target the right position based on their skills and credentials.

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Weekday Optum Utilization Review jobs near you

Botox Utilization Review Specialist - Phoenix, AZ

HealthOp Solutions

Phoenix, AZ

$20 - $25/hr

Full-time

Posted 27 days ago

Key responsibilities

  • Review medical records to validate diagnoses and supporting documentation.

  • Submit prior authorization requests for Botox treatments using appropriate codes and documentation.

  • Research denied requests and submit appeals with required clinical documentation.

Job description

Job Title: Botox Utilization Review Specialist

Location: Phoenix, AZ

Hours & Schedule: Full-time, Monday through Friday, mornings to 4:00 PM

Work Environment: Neurology Clinic

Salary / Hourly Rate: $20–25 per hour


Why work with us:

This position plays a vital role in ensuring patients receive timely access to medically necessary therapeutic Botox treatments. The role offers a consistent weekday schedule and the opportunity to work closely with clinical teams and insurance payers in a fast-paced, supportive healthcare environment.


What our ideal new team member looks like:

The ideal team member is detail-oriented, highly organized, and experienced in utilization review and prior authorizations. They are comfortable interpreting clinical documentation, navigating payer requirements, and communicating clearly with patients and healthcare staff. They are proactive, collaborative, and committed to supporting quality patient care.


Job Summary:

The Botox Utilization Review Specialist is responsible for obtaining insurance authorization for therapeutic Botox injections, including treatments for migraines, spasms, dystonia, and hyperhidrosis. This role reviews medical records for clinical necessity, verifies benefits, submits authorization requests, and manages denials and appeals. Strong knowledge of insurance processes, medical terminology, and documentation standards is required to ensure timely treatment approval.


Job Duties & Responsibilities:

  • Review medical records to validate diagnoses and supporting documentation
  • Submit prior authorization requests using appropriate ICD-10 and CPT codes
  • Verify medical necessity based on payer-specific clinical criteria
  • Coordinate with insurance carriers to confirm eligibility, benefits, and coverage limitations
  • Track pending, approved, and denied authorizations within the electronic health record
  • Research denied requests and submit appeals with required clinical documentation
  • Communicate authorization status and potential out-of-pocket costs to patients and clinical staff
  • Maintain accurate records while handling confidential information with professionalism


Prerequisites / License & Certification Requirements:

  • High School Diploma or GED
  • Minimum of 3 years of experience in prior authorizations, referrals, or a related medical office role
  • Knowledge of insurance processes and medical terminology
  • Experience using Athena is required
  • Understanding of ICD-10 and CPT coding
  • Strong multitasking and organizational skills
  • Ability to perform efficiently in a high-volume, fast-paced environment
  • Excellent communication, problem-solving, and team collaboration skills


How to Apply

If you’re ready to contribute your skills to a respected neurology practice and grow within a supportive environment, please submit your updated resume for confidential consideration. Cover letters and references are encouraged but not required.


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