ZipRecruiter

Log In

1

Weekday Optum Utilization Review Jobs (NOW HIRING)

Clarvida - Georgia

Utilization Manager

Columbus, GA · On-site

Performs Utilization Management reviews, to include On Hold reports, and coordinates resolution of ... * 8:30am-5:00pm weekday office schedule * Stability and growth opportunities working with a ...

Clarvida - Georgia

Utilization Manager

Augusta, GA · On-site

Performs Utilization Management reviews, to include On Hold reports, and coordinates resolution of ... * 8:30am-5:00pm weekday office schedule * Stability and growth opportunities working with a ...

Clarvida - Georgia

Utilization Manager

Savannah, GA · On-site

Performs Utilization Management reviews, to include On Hold reports, and coordinates resolution of ... * 8:30am-5:00pm weekday office schedule * Stability and growth opportunities working with a ...

Clarvida - Georgia

Utilization Manager

Columbus, GA · On-site

Performs Utilization Management reviews, to include On Hold reports, and coordinates resolution of ... * 8:30am-5:00pm weekday office schedule * Stability and growth opportunities working with a ...

Clarvida

Utilization Manager

Columbus, GA · On-site

Performs Utilization Management reviews, to include On Hold reports, and coordinates resolution of ... * 8:30am-5:00pm weekday office schedule * Stability and growth opportunities working with a ...

Clarvida

Utilization Manager

Savannah, GA

Performs Utilization Management reviews, to include On Hold reports, and coordinates resolution of ... * 8:30am-5:00pm weekday office schedule * Stability and growth opportunities working with a ...

Clarvida - Georgia

Utilization Manager

Savannah, GA · On-site

Performs Utilization Management reviews, to include On Hold reports, and coordinates resolution of ... * 8:30am-5:00pm weekday office schedule * Stability and growth opportunities working with a ...

next page

Showing results 1-20

All JobsWeekday Optum Utilization Review Jobs

Weekday Optum Utilization Review information

See salary details

$21

$42

$68

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

As of Jul 21, 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.

More about Weekday Optum Utilization Review jobs
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:
What states have the most Weekday Optum Utilization Review jobs? States with the most job openings for Weekday Optum Utilization Review jobs include:
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
Infographic showing various Weekday Optum Utilization Review job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 85% Full Time, 12% Part Time, and 2% Summer. Highlights an 92% Physical, and 8% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Weekend RN Coordinator Utilization Management (1.0 FTE)

Weekend RN Coordinator Utilization Management (1.0 FTE)

Network Health

Menasha, WI • On-site

Other

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

Job description

Description

The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable guidelines regarding payment and coverage, and makes determinations for authorization/payment.

Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha is required occasionally for the position, including on first day. Training is required in person at our Menasha location for the first 6-8 weeks, Monday through Friday 8am - 5pm.

Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Saturday and Sunday core hours, weekdays available to make up remaining 40 hours. August - September 2026 start date.

Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Job Responsibilities:

  • Evaluate and process prior authorization requests/referrals submitted from contracted and non-contracted providers
  • Follow Network Health process, policies, and procedures in authorization review of all membership on a pre-service, concurrent and post-service basis. This process includes verifying eligibility and benefits, as well as documenting all utilization management communication
  • Provide education regarding utilization management activities and processes to members, caregivers, providers, and their administrative staff
  • Participate in Utilization Management auditing (i.e. Utilization Management Inter-reviewer reliability and denial files)
  • Refer all members with complex health problems and needs to Network Health Case Management to reduce medical costs while providing a higher quality of life and an ability to take charge of their diseases. This requires an extensive holistic approach to care management assessment
  • Collaborate with other NH departments to develop interdepartmental operational processes
  • Support Utilization Management department programs and goals through active participation
  • Identify and screen candidates for Case Management intervention and determines appropriate level of care from Utilization Management criteria
  • Complete assessments and plans of care including need for medication regime, treatment plans, practitioner follow-up appointments, knowledge of red flags, disease management, Advance Directives, life planning, and self-management of illness to the best of member ability
  • Evaluate cases for cost savings/quality improvement potential
  • Other duties and responsibilities as assigned

Job Requirements:

  • Bachelor of Science in Nursing, preferred
  • Associate Degree in Nursing, required
  • Current registered nurse licensure in Wisconsin required
  • Minimum of four (4) years clinical health care experience as a Registered Nurse (RN) required
  • Experience in insurance, managed care and utilization management preferred

Network Health is an Equal Opportunity Employer

Qualifications

Licenses & Certifications
Registered Nurse (preferred)

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

Apply