Reviews behavioral health cases to determine medical necessity and appropriateness of care ... Conducts utilization reviews of behavioral health cases to determine medical necessity ...
Reviews behavioral health cases to determine medical necessity and appropriateness of care ... Conducts utilization reviews of behavioral health cases to determine medical necessity ...
Care Review Nurse
Columbus, OH · On-site
... utilization management activities aimed at providing Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require ...
Care Review Nurse
Columbus, OH · On-site
... utilization management activities aimed at providing Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require ...
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...
Company Description Why You Should Work For Us: HealthCare Support Staffing, Inc. (HSS), is a ... Conducts prior authorization reviews to determine financial responsibility Qualifications * 2 years ...
Company Description Why You Should Work For Us: HealthCare Support Staffing, Inc. (HSS), is a ... Conducts prior authorization reviews to determine financial responsibility Qualifications * 2 years ...
Monitors and reviews MCO portals to track authorization status, pending requests, approvals ... Bachelor's Degree preferred in Healthcare Administration, Business Administration, Social Work ...
Monitors and reviews MCO portals to track authorization status, pending requests, approvals ... Bachelor's Degree preferred in Healthcare Administration, Business Administration, Social Work ...
We believe that no one should have to navigate the cost and complexity of healthcare alone, and we ... The Transplant Nurse, Utilization Review provides the highest level of clinical service both ...
We believe that no one should have to navigate the cost and complexity of healthcare alone, and we ... The Transplant Nurse, Utilization Review provides the highest level of clinical service both ...
The Transplant Nurse, Utilization Review provides the highest level of clinical service both ... Utilize Quantum Health adopted clinical criteria during all aspects of the review process and ...
The Transplant Nurse, Utilization Review provides the highest level of clinical service both ... Utilize Quantum Health adopted clinical criteria during all aspects of the review process and ...
The Transplant Nurse, Utilization Review provides the highest level of clinical service both ... Utilize Quantum Health adopted clinical criteria during all aspects of the review process and ...
The Transplant Nurse, Utilization Review provides the highest level of clinical service both ... Utilize Quantum Health adopted clinical criteria during all aspects of the review process and ...
We believe that no one should have to navigate the cost and complexity of healthcare alone, and we ... The Transplant Nurse, Utilization Review provides the highest level of clinical service both ...
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We believe that no one should have to navigate the cost and complexity of healthcare alone, and we ... The Transplant Nurse, Utilization Review provides the highest level of clinical service both ...
UR Coordinator, Full Time
$24 - $32/hr
Experience in utilization review, case management, medical records, or healthcare billing strongly preferred * Strong understanding of insurance authorization processes (Medicare, Medicaid, and ...
UR Coordinator, Full Time
$24 - $32/hr
Experience in utilization review, case management, medical records, or healthcare billing strongly preferred * Strong understanding of insurance authorization processes (Medicare, Medicaid, and ...
Participates as an active management member of the Mount Carmel Health Plan representing the Utilization Review Department in collaboratively meeting operational, budget, and strategic planning goals ...
Participates as an active management member of the Mount Carmel Health Plan representing the Utilization Review Department in collaboratively meeting operational, budget, and strategic planning goals ...
Care Review Clinician
Columbus, OH · On-site
... utilization management activities aimed at providing healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require ...
Care Review Clinician
Columbus, OH · On-site
... utilization management activities aimed at providing healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require ...
Care Review Clinician
Columbus, OH · On-site
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...
Care Review Clinician
Columbus, OH · On-site
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...
UR Manager
Columbus, OH · On-site
For billing and hospitalization utilization review purposes, the reviewer will identify and certify ... Health Savings Account 401(k) aftersixty days Paid Parental Leave
UR Manager
Columbus, OH · On-site
For billing and hospitalization utilization review purposes, the reviewer will identify and certify ... Health Savings Account 401(k) aftersixty days Paid Parental Leave
Care Review Processor I
Columbus, OH · On-site
... utilization review for other healthcare services. Checks eligibility and verifies benefits, obtains and enters data into systems, processes requests, and triages members and information to the ...
Care Review Processor I
Columbus, OH · On-site
... utilization review for other healthcare services. Checks eligibility and verifies benefits, obtains and enters data into systems, processes requests, and triages members and information to the ...
Family Practice Physician Outpatient Only Practitioner - Physicians Only Apply - Perm
$215K - $344K/yr
Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality. Reviews claims involving ...
Family Practice Physician Outpatient Only Practitioner - Physicians Only Apply - Perm
$215K - $344K/yr
Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality. Reviews claims involving ...
Nursing experience may include inpatient nursing, case management, utilization review, discharge planning, community health nursing. * Utilization review, and/or discharge planning experience ...
Nursing experience may include inpatient nursing, case management, utilization review, discharge planning, community health nursing. * Utilization review, and/or discharge planning experience ...
Nursing experience may include inpatient nursing, case management, utilization review, discharge planning, community health nursing. * Utilization review, and/or discharge planning experience ...
Nursing experience may include inpatient nursing, case management, utilization review, discharge planning, community health nursing. * Utilization review, and/or discharge planning experience ...
Nursing experience may include inpatient nursing, case management, utilization review, discharge planning, community health nursing. * Utilization review, and/or discharge planning experience ...
Nursing experience may include inpatient nursing, case management, utilization review, discharge planning, community health nursing. * Utilization review, and/or discharge planning experience ...
Nursing experience may include inpatient nursing, case management, utilization review, discharge planning, community health nursing. * Utilization review, and/or discharge planning experience ...
Nursing experience may include inpatient nursing, case management, utilization review, discharge planning, community health nursing. * Utilization review, and/or discharge planning experience ...
Optum Health Utilization Review information
See salary details
$21.39 - $25.72
2% of jobs
$25.72 - $30.05
9% of jobs
$33.01 is the 25th percentile. Wages below this are outliers.
$30.05 - $34.38
21% of jobs
The median wage is $37.88 / hr.
$34.38 - $38.70
23% of jobs
$38.70 - $43.03
13% of jobs
$46.39 is the 75th percentile. Wages above this are outliers.
$43.03 - $47.36
10% of jobs
$47.36 - $51.68
8% of jobs
$51.68 - $56.01
5% of jobs
$56.01 - $60.34
5% of jobs
$60.34 - $64.66
2% of jobs
$64.66 - $68.99
2% of jobs
$21
$42
$68
How much do optum health utilization review jobs pay per hour?
As of Aug 30, 2026, the average hourly pay for optum health 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 are popular job titles related to Optum Health Utilization Review jobs?
For Optum Health Utilization Review jobs, the most frequently searched job titles are:
- Behavioral Health Solutions
- Heartland Behavioral Healthcare
- Behavioral Health Utilization Review Nurse
- 3Rd Shift Behavioral Health Utilization Review
- Renaissance Behavioral Health Systems
- Evening Optum Health Utilization Review
- Vice President Behavioral Health Utilization Review
- Remote Behavioral Health Rn
- Remote Behavioral Health Utilization Review
- Full Time Remote Utilization Review Nurse
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The top searched job categories for Optum Health Utilization Review jobs are:
What cities are hiring for Optum Health Utilization Review jobs?
Cities with the most Optum Health Utilization Review job openings:
What states have the most Optum Health Utilization Review jobs?
States with the most job openings for Optum Health Utilization Review jobs include:
What are the most commonly searched types of Optum Health Utilization Review jobs?
The most popular types of Optum Health Utilization Review jobs are:
Full-time
Re-posted 9 days ago
Nationwide Children's Hospital rating
6.9
Based on 131 frontline employees who took The Breakroom Quiz
552nd of 1,064 rated hospitals
Job description
Overview:
Schedule: Monday-Friday (8:00am-4:30pm)
Position is work from home after a 90 day in-office training period.
Job Description Summary:
Reviews behavioral health cases to determine medical necessity and appropriateness of care, ensuring compliance with established guidelines and policies. Performs pre-certifications, pre-authorizations, re-authorization, concurrent utilization reviews, retrospective reviews, and denial management. Interacts with staff and departments of the hospital to facilitate appropriate, cost-effective patient care.
Job Description:
Essential Functions:
Education Requirement:
Bachelor's Degree in Social Work, Psychology, or related field, required.
Licensure Requirement:
(not specified)
Certifications:
(not specified)
Skills:
Experience:
Physical Requirements:
OCCASIONALLY: Bend/twist, Climb stairs/ladder, Flexing/extending of neck, Lifting / Carrying: 0-10 lbs, Reaching above shoulder, Squat/kneel
FREQUENTLY: Standing, Walking
CONTINUOUSLY: Audible speech, Color vision, Computer skills, Decision Making, Depth perception, Hand use: grasping, gripping, turning, Hearing acuity, Interpreting Data, Peripheral vision, Problem solving, Repetitive hand/arm use, Seeing - Far/near, Sitting
Additional Physical Requirements performed but not listed above:
(not specified)
"The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"
Schedule: Monday-Friday (8:00am-4:30pm)
Position is work from home after a 90 day in-office training period.
Job Description Summary:
Reviews behavioral health cases to determine medical necessity and appropriateness of care, ensuring compliance with established guidelines and policies. Performs pre-certifications, pre-authorizations, re-authorization, concurrent utilization reviews, retrospective reviews, and denial management. Interacts with staff and departments of the hospital to facilitate appropriate, cost-effective patient care.
Job Description:
Essential Functions:
- Conducts utilization reviews of behavioral health cases to determine medical necessity, appropriateness of care, and adherence to clinical guidelines.
- Communicates with healthcare teams and third-party payors to ensure the delivery of quality care and optimum payment.
- Assists with retrospective reviews and denial management to maintain appropriate and cost-effective patient care.
- Documents all case reviews and maintains accurate records of all clinical activities and coverage information.
- Provides education and support regarding utilization review and management activities and processes.
- Analyzes clinical data to identify trends and patterns that may impact patient care. Participates in quality improvement initiatives to enhance the overall delivery of behavioral health services.
- Facilitates reimbursement by communicating with payers, other staff, patients, and families concerning status of funding and required actions.
Education Requirement:
Bachelor's Degree in Social Work, Psychology, or related field, required.
Licensure Requirement:
(not specified)
Certifications:
(not specified)
Skills:
- Excellent written and verbal communication and interpersonal skills.
- Excellent customer service and organizational skills.
- Working knowledge of CMS and other review agency standards.
- Proficient with software applications including CM, payer web applications, MITS, and others.
Experience:
- Three years of behavioral health experience, required.
- One year of experience in pediatric care or services, required.
- Utilization review or utilization management experience, preferred.
Physical Requirements:
OCCASIONALLY: Bend/twist, Climb stairs/ladder, Flexing/extending of neck, Lifting / Carrying: 0-10 lbs, Reaching above shoulder, Squat/kneel
FREQUENTLY: Standing, Walking
CONTINUOUSLY: Audible speech, Color vision, Computer skills, Decision Making, Depth perception, Hand use: grasping, gripping, turning, Hearing acuity, Interpreting Data, Peripheral vision, Problem solving, Repetitive hand/arm use, Seeing - Far/near, Sitting
Additional Physical Requirements performed but not listed above:
(not specified)
"The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"
What Nationwide Children's Hospital employees say
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Benefits
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Workplace
Get the full story on Breakroom
About Nationwide Children's Hospital
Sourced by ZipRecruiter
Nationwide Children's Hospital, established in 1894, is a leading pediatric healthcare system based in Columbus, Ohio, United States. They serve as a primary pediatric network, providing wellness, preventive, diagnostic, treatment, and rehabilitative care for infants, children, adolescents, and adults with congenital disease. Being the third-largest pediatric hospital in the nation, Nationwide Children's Hospital prides itself on its relentless commitment to children and their families, driven by their core values of respect, integrity, determination, empathy, and solidarity. The institution's comprehensive mission is to enhance the health of children by providing high-quality, family-centered care, conducting groundbreaking research, advocating for pediatric health, and training top healthcare professionals.
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Columbus, OH, US
Year founded
1892