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Weekday Optum Utilization Review Jobs (NOW HIRING)

UnitedHealth Group

Case Manager Optum Oveido

Oviedo, FL

$60K - $107K/yr

Optum is a clinician-led care organization that is changing the way clinicians work and live. As a ... Care management, utilization review or discharge planning experience * HMO experience * Ability to ...

UnitedHealth Group

Case Manager Optum Oveido

Oviedo, FL · On-site

$60K - $107K/yr

Optum is a clinician-led care organization that is changing the way clinicians work and live. As a ... Care management, utilization review or discharge planning experience * HMO experience * Ability to ...

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Weekday Optum Utilization Review information

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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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What cities are hiring for Weekday Optum Utilization Review jobs? Cities with the most Weekday Optum Utilization Review job openings:
What are the most commonly searched types of Optum Utilization Review jobs? The most popular types of Optum Utilization Review jobs are:
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What job categories do people searching Weekday Optum Utilization Review jobs look for? The top searched job categories for Weekday Optum Utilization Review jobs are:
Weekday Optum Utilization Review jobs near you
Utilization Reviewer-Behavioral Health Casual Status Days

Utilization Reviewer-Behavioral Health Casual Status Days

Northwestern Memorial Healthcare

Woodstock, IL • On-site

Other

Retirement

This job post has expired today. Applications are no longer accepted.

Northwestern Medicine rating

7.7

Company rating: 7.7 out of 10

Based on 383 frontline employees who took The Breakroom Quiz

160th of 877 rated healthcare providers

Job description

Company Description
At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better health care, no matter where you work within the Northwestern Medicine system. We pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, our goal is to take care of our employees. Ready to join our quest for better?
Job Description
*Shifts are weekdays.
The Utilization Reviewer reflects the mission, vision, and values of NM, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.
Responsibilities:
  • Responsible for utilization review calls within BHS, including precertification, continued stay review, discharge reviews, and retrospective reviews and appeals.
  • Under the direction of the Utilization Review Coordinator, works closely with business office staff, clinical staff, and physicians to advocate for BHS patients with insurance and managed care companies.
  • Familiar with and understands DSM diagnoses and ASAM patient placement criteria to communicate patient status to external managed care.
  • Communicates insurance input to physicians and clinical staff making discharge plans for patients. Assists clinical staff with assessments as needed, primarily as in a back-up capacity.
  • Communicates daily with Utilization Review Coordinator, and as needed with business office and admissions staff to understand admissions and transfers, patient benefit information, and precertification status, including making precertification or notice of admission calls on patients directly to minimize financial risk to patient and facility.
  • Understands health care benefit plan provisions and managed care contracting, and communicates benefits and approval status of patients to clinical staff and physicians, and to patients and family members when needed.
  • Serves as professional representative of BHS when interacting with reviewers from insurance companies, employers, and managed care plans, and contributes to BHS marketing strategies.
  • Communicates and coordinates efforts at appealing unfavorable utilization review decisions, scheduling physician reviews, and monitoring denials and appeals, reporting to Utilization Review Coordinator. EOE Minorities/Women/Disabled/Veterans. VEVRAA Federal Contractor.
Qualifications
Required:
  • 2+ years of experience.
  • Master's Degree in Social Work or Psychology or BSN with RN License.
Preferred:
  • BSN with RN License. CERT BLS, CERT CADC, CERT CSADC, LIC CPC, LIC LCSW, LIC MSW, LIC RN.

Additional Information
Northwestern Medicine is an equal opportunity employer (disability, VETS) and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.
Background Check
Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check. Results are evaluated on a case-by-case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act.
Artificial Intelligence Disclosure
Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.
Benefits
We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.
Sign-on Bonus Eligibility (if sign-on bonus offered for position): Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign on bonus. Exception: New graduate internal employees seeking their first licensed clinical position at NM may be eligible depending upon the job family.

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