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Director Remote Utilization Review Jobs in Riverside, CA

Berkadia

Director Investment Sales

Irvine, CA · On-site +1

Stay informed about commercial real estate and market trends by reviewing industry literature and ... Be Berkadia. #LI-RECRUITER INITALS (#LI-HYBRID, #LI-ONSITE, #LI-REMOTE, #LI-DNI)

Wastequip

Director of Sales

Jurupa Valley, CA · Remote

$145K - $170K/yr

Lead weekly pipeline and KPI reviews to monitor activity levels, forecast accuracy, and deal ... Ability to work independently in a remote environment while collaborating with cross-functional ...

Wastequip

Director of Sales

Ontario, CA · Remote

$145K - $170K/yr

Lead weekly pipeline and KPI reviews to monitor activity levels, forecast accuracy, and deal ... Ability to work independently in a remote environment while collaborating with cross-functional ...

Wastequip

Director of Sales

Ontario, CA · Remote

$145K - $170K/yr

Lead weekly pipeline and KPI reviews to monitor activity levels, forecast accuracy, and deal ... Ability to work independently in a remote environment while collaborating with cross-functional ...

Wastequip

Director of Sales

Jurupa Valley, CA · Remote

$145K - $170K/yr

Lead weekly pipeline and KPI reviews to monitor activity levels, forecast accuracy, and deal ... Ability to work independently in a remote environment while collaborating with cross-functional ...

BPM LLP

Tax Director - Flowthrough

Irvine, CA · On-site +1

$180K - $220K/yr

As a Tax Director (Flowthrough), you will be responsible for reviewing, analyzing, and building ... Champion sustainable workplace practices by supporting remote-first operations, promoting paperless ...

New

BPM LLP

Tax Director - Flowthrough

Irvine, CA · On-site +1

As a Tax Director (Flowthrough), you will be responsible for reviewing, analyzing, and building ... Champion sustainable workplace practices by supporting remote-first operations, promoting paperless ...

New

BPM LLP

Tax Director - Nonprofit (NFP)

Irvine, CA · On-site +1

$160K - $227K/yr

... reviews and risk management. * Advise on UBIT/UBTI analyses, structuring of programrelated ... Champion sustainable workplace practices by supporting remote-first operations, promoting paperless ...

antidote

Campaign Manager (Remote)

Santa Ana, CA · Remote

... direct marketers." we're not that....we genuinely love brands, design, all things creative ... review results consistently to create iteration and testing plans (both for automation and weekly ...

Qcells

Director of Loss Mitigation

Irvine, CA · On-site +1

$150K - $180K/yr

... review service. QSS monitors all assets proactively to resolve any issue, so that maximizes ... The position will be based in Irvine, CA, Houston, TX or San Francisco, CA, or remote.

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All JobsDirector Remote Utilization Review JobsDirector Remote Utilization Review Jobs in Riverside, CA

Director Remote Utilization Review information

See Riverside, CA salary details

$22

$44

$71

How much do director remote utilization review jobs pay per hour?

As of Jun 1, 2026, the average hourly pay for director remote utilization review in Riverside, CA is $44.11, according to ZipRecruiter salary data. Most workers in this role earn between $34.86 and $50.67 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Director of Remote Utilization Review, and why are they important?

To thrive as a Director of Remote Utilization Review, you need in-depth knowledge of healthcare regulations, utilization management processes, and a relevant clinical background, typically supported by an RN or other clinical licensure and experience in case management. Familiarity with utilization review software, electronic health records (EHR), and certifications such as CCM or UM are often required. Leadership, analytical thinking, and strong communication skills are vital for guiding teams and collaborating with stakeholders. These skills ensure effective oversight of remote teams, regulatory compliance, and optimal patient care outcomes.

How does a Director of Remote Utilization Review typically collaborate with clinical and administrative teams to ensure effective patient care management?

A Director of Remote Utilization Review plays a pivotal role in bridging clinical staff, case managers, and administrative teams to optimize patient care and resource utilization. This is often achieved through regular virtual meetings, data sharing, and cross-departmental strategy sessions to review utilization trends and address barriers to care. The director ensures that remote teams adhere to regulatory standards and organizational goals, fostering open communication to streamline workflows and resolve complex cases efficiently. Successful collaboration enhances patient outcomes, reduces unnecessary costs, and maintains compliance, all while supporting a positive remote team environment.

What is a Director of Remote Utilization Review?

A Director of Remote Utilization Review is a healthcare leader responsible for overseeing teams that assess the necessity, appropriateness, and efficiency of medical services, typically from a remote or virtual environment. This role ensures compliance with regulatory guidelines, optimizes resource use, and helps manage healthcare costs while maintaining quality patient care. Directors collaborate with physicians, nurses, and insurance providers to review clinical cases and develop utilization review strategies. They also monitor performance metrics and implement process improvements for remote teams.

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

AspectDirector Remote Utilization ReviewUtilization Review Nurse
CredentialsTypically requires a nursing license, advanced degree, and management experienceRegistered Nurse (RN) license, relevant clinical experience
Work EnvironmentOversees teams remotely, strategic planning, policy developmentConducts patient reviews, collaborates with healthcare providers, often remote or onsite
Employer & Industry UsageHealth insurance companies, managed care organizationsHospitals, insurance companies, healthcare facilities

The main difference is that the Director Remote Utilization Review focuses on managing teams and policies remotely, while the Utilization Review Nurse performs clinical reviews directly related to patient care. The director has a broader strategic role, whereas the nurse role is more clinical and operational.

What are the most commonly searched types of Remote Utilization Review jobs in Riverside, CA? The most popular types of Remote Utilization Review jobs in Riverside, CA are:
What are popular job titles related to Director Remote Utilization Review jobs in Riverside, CA? For Director Remote Utilization Review jobs in Riverside, CA, the most frequently searched job titles are:
What job categories do people searching Director Remote Utilization Review jobs in Riverside, CA look for? The top searched job categories for Director Remote Utilization Review jobs in Riverside, CA are:
What cities near Riverside, CA are hiring for Director Remote Utilization Review jobs? Cities near Riverside, CA with the most Director Remote Utilization Review job openings:
Director Remote Utilization Review jobs near you

Provider Quality Review Nurse, RN

Inland Empire Health Plan

Rancho Cucamonga, CA • On-site, Remote

$91.25K - $120.91K/yr

Full-time

Posted 4 days ago

Job description

Overview
This is a short-term assignment.
What you can expect!
Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience!
At Inland Empire Health Plan (IEHP), we believe the highest quality of care should be delivered to all in the Inland Empire. We are thinking beyond the way Quality is viewed today - we believe it should be holistic and transformative. IEHP's provider incentive programs serve an important role in achieving IEHP's quality goals.
Reporting to the Manager of Provider Quality Oversight, the Provider Quality Review Nurse, RN is responsible for:
  • Receive and research all PQI and QR cases as assigned, provide a summary and recommendations to the Medical Director of case assignments
  • Effectuate all action items as determined by the Medical Director to resolution of case assignments
  • Reviewing escalated issues
  • Discussing and reviewing cases with Medical Directors referred to the Quality Management (QM) department
  • Investigation of cases includes, but not limited to, the documentation of case summaries, follow up actions, outreach efforts, and communications in the QM database

Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Key Responsibilities
  1. Investigate and complete case summaries and make recommendations for any Potential Quality of Care Incidents (PQI) referred to the QM department.
  2. Maintain direct communication with IEHP departments, external facilities including hospitals, Skilled Nursing Facilities, and/or Providers to ensure all PQI issues are thoroughly investigated, and care is coordinated in a timely manner, as needed.
  3. Review requested medical records to ensure complete case documentation is received from all practitioners, providers, and entities/agencies to ensure thorough investigation of the issue.
  4. Review case findings and recommendations with Medical Director. Issue Corrective Action Plans (CAP), review CAP responses, draft Opportunity for Improvement letters, and coordinate other interventions as needed to ensure all issues were addressed and future occurrences of the same issue are mitigated.
  5. Complete data entry into database systems, maintain updated documentation and other tracking mechanisms for all cases.
  6. Review and execute ad hoc requests, quality reviews, and/or focused audits, as needed.
  7. Escalate issues of non-compliance to the Quality Systems Management team.
  8. Maintain working knowledge of regulatory requirements as they relate to QM operations and protocols.
  9. Complete other tasks and assignments based on department and business needs.
  10. Demonstrate a commitment to incorporate LEAN principles into daily work.

Qualifications
Education & Requirements
  • Three (3) or more years of any individual or combined healthcare experience in quality assurance, quality management, quality improvement, utilization management, discharge planning, and/or case management
  • Three (3) or more years of work experience in a managed care, hospital, provider practice, or other comparable healthcare experience
  • Experience preferably in a quality/performance improvement setting
  • Bachelor's degree in Nursing from an accredited institution required
    • In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position
    • This experience is in addition to the minimum years listed in the Experience Requirements above
  • Certified Professional in Healthcare Quality (CPHQ), Certified Professional in Healthcare Risk Management (CPHRM), or Clinical certification in area specialty) preferred
  • Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required

Key Qualifications
  • Must have a valid California Driver's License
  • Excellent understanding of performance improvement, quality assurance, and utilization management
  • Knowledgeable in clinical analysis of health records, assessing or evaluating quality, and identifying problems or issues with care delivery
  • Microcomputer applications: spreadsheet, database, and word processing
  • Excellent written and verbal communication skills
  • Excellent coordination skills
  • Ability to communicate findings and form recommendations based on clinical case reviews
  • Ability to demonstrate critical thinking, strong problem-solving capability. Strong attention to detail
  • Ability to prioritize work to ensure adherence to project deadlines. Ability to effectively escalate issues as identified, following established protocols
  • Positive attitude and ability to work in a team setting
  • Self-direction and ability to work with minimal supervision
  • Word processing and data entry involving computer keyboard and screens, automobile travel within the Inland Empire
  • Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval

Start your journey towards a thriving future with IEHP and apply TODAY!
Work Model Location
Telecommute (All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership)
Pay Range
USD $91,249.60 - USD $120,910.40 /Yr.

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