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Assistant Remote Utilization Review Jobs in California

Corvel

Professional Review Nurse

Folsom, CA · Remote

$70K - $85K/yr

This is a remote position in CA. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Identify the necessity ... Prospective, concurrent and retrospective utilization review experience preferred PAY RANGE: CorVel ...

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Assistant Remote Utilization Review information

What is the difference between Assistant Remote Utilization Review vs Utilization Review Nurse?

AspectAssistant Remote Utilization ReviewUtilization Review Nurse
CredentialsTypically requires a nursing license, certification in case management or utilization reviewRegistered Nurse (RN) license, often with additional certifications in case management or utilization review
Work EnvironmentRemote, administrative setting, telehealth or telecommutingRemote or hospital/clinic settings, primarily telehealth or administrative
Employer & IndustryHealth insurance companies, managed care organizations, healthcare providersHospitals, insurance companies, healthcare organizations

Both roles involve reviewing patient cases to determine appropriate care and resource utilization. The Assistant Remote Utilization Review typically supports the process with administrative tasks and basic review, while the Utilization Review Nurse performs more in-depth clinical assessments. Both require nursing credentials and often work remotely within healthcare or insurance industries.

What are the most commonly searched types of Remote Utilization Review jobs in California? The most popular types of Remote Utilization Review jobs in California are:
What are popular job titles related to Assistant Remote Utilization Review jobs in California? For Assistant Remote Utilization Review jobs in California, the most frequently searched job titles are:
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Assistant Remote Utilization Review jobs near you

Medical Director - Utilization Management (Part-Time or Full-Time)

Astrana Health, Inc.

Monterey Park, CA • Remote

$275K - $315K/yr

Full-time

Re-posted 27 days ago

Job description

Description
Astrana is seeking a California-licensed Medical Director - Utilization (UM) to provide clinical oversight and strategic leadership through our utilization review operations to ensure members receive high-quality, medically appropriate, and cost-effective care. This is a critical, cross-functional role that bridges clinical expertise with operational execution across value-based care, capitated models, and delegated risk structures.

In this role, you’ll apply evidence-based criteria to utilization decisions, mentor clinical review teams, and support compliance with all applicable regulatory and contractual obligations. We are seeking candidates with extensive outpatient UM experience. 
  
This position is ideal for a clinically grounded physician who thrives in a data-informed, team-based environment and is passionate about transforming how care is delivered in a risk-bearing, population health-focused ecosystem.
We are open to part-time (three full 8 hour shifts from 8 AM - 5 PM PST) or full-time (32+ hours per week).
Our Values:  
  • Put Patients First  
  • Empower Entrepreneurial Provider and Care Teams  
  • Operate with Integrity & Excellence  
  • Be Innovative  
  • Work As One Team 

What You'll Do
  • Provide physician oversight and final determination for outpatient utilization management activities, including prior authorizations, retrospective reviews, and appeals.
  • Ensure medical necessity and appropriateness of outpatient services such as specialty referrals, diagnostics, imaging, DME, therapies, and procedures.
  • Support compliance with delegated health plan requirements, regulatory standards, and accreditation guidelines.
  • Conduct peer‑to‑peer reviews and outpatient physician education to improve documentation, guideline adherence, and appropriate utilization.
  • Partner with Outpatient Medical Directors, Population Health, and UM nursing teams to align utilization decisions with Astrana’s value‑based care strategy.
  • Identify outpatient utilization trends, leakage, and variation; recommend clinical strategies to improve cost efficiency and quality outcomes.
  • Serve as clinical liaison with health plans and external vendors on outpatient UM‑related matters.

Qualifications
  • MD or DO; Board Certified in Internal Medicine, Family Medicine, or a relevant outpatient specialty required.
  • Active, unrestricted medical license (California required).
  • Prior experience in outpatient utilization management, health plan medical management, or delegated risk environments.
  • Strong understanding of outpatient medical necessity criteria, prior authorization workflows, and appeals processes.
  • Experience working with PCPs and ambulatory specialists in value‑based care models.
  • Strong physician‑to‑physician communication and clinical judgment.

Environmental Job Requirements and Working Conditions
  • This is a remote position. The position will operate in Pacific Standard Time. 
  • The national target base salary range for this role is: $275,000 - $325,000. Actual compensation will be determined based on geographic location (current or future), experience, or other job-related factors. Salary will be pro-rated based on agreed upon hours. 
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.