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Overnight Remote Utilization Review Jobs in California

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · Remote

$30.64 - $45.80/hr

The Utilization Review Nurse gathers demographic and clinical information on prospective ... This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Identifies the necessity of ...

Astrana Health, Inc.

UM Review Nurse

Monterey Park, CA · Remote

$34 - $47/hr

Description Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our ... This is a remote position for CA-licensed nurses. Candidates must live in California. We are ...

Astrana Health

UM Review Nurse

Monterey Park, CA · Remote

$34 - $47/hr

Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services ... This is a remote position for CA-licensed nurses. Candidates must live in California. We are ...

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Overnight Remote Utilization Review information

What is the difference between Overnight Remote Utilization Review vs Daytime Remote Utilization Review?

AspectOvernight Remote Utilization ReviewDaytime Remote Utilization Review
Work HoursTypically overnight shifts, often 10 PM to 6 AMStandard daytime hours, usually 8 AM to 4 PM
CertificationsSame as utilization review roles, e.g., RN, CPC, or other healthcare credentialsSame as overnight roles, requiring similar certifications
Work EnvironmentRemote, focused on reviewing cases during night hoursRemote, reviewing cases during daytime hours
Employer & IndustryHealthcare insurance companies, third-party administratorsSame as overnight, within healthcare and insurance sectors

Overnight Remote Utilization Review involves reviewing cases during night hours, providing flexibility for healthcare providers and insurers. Daytime Remote Utilization Review occurs during regular business hours. Both roles require similar credentials and work environments but differ mainly in shift timing, catering to different operational needs.

What are the main challenges faced by overnight remote utilization review professionals, and how can they be addressed?

Overnight remote utilization review professionals often encounter challenges such as working independently during non-traditional hours, limited immediate access to colleagues or supervisors, and the need to make timely decisions with potentially less available support. To address these challenges, it is important to develop strong self-management skills, establish clear communication channels with team members, and utilize comprehensive digital resources and documentation. Employers typically provide thorough training and access to on-call support to help ensure that overnight staff can make confident, accurate determinations and maintain high-quality patient care standards.

What are the key skills and qualifications needed to thrive as an overnight remote utilization review?

To thrive as an Overnight Remote Utilization Review nurse, you need a current RN license, strong clinical judgment, and experience in acute care or case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance guidelines such as Medicare/Medicaid are typically required. Excellent critical thinking, attention to detail, and the ability to communicate clearly in written and verbal forms are vital soft skills for this role. These skills ensure accurate, timely case reviews and effective collaboration with healthcare providers while maintaining compliance with payer requirements.

What is an overnight remote utilization review?

An Overnight Remote Utilization Review position involves evaluating medical records and healthcare services during nighttime hours to ensure that treatments are medically necessary and meet established guidelines. Professionals in this role usually work from home, reviewing patient cases, authorizing or denying services, and collaborating with healthcare providers. This job is crucial for maintaining quality care while controlling healthcare costs, and it often requires clinical credentials such as RN, LPN, or other relevant certifications. Strong analytical, communication, and computer skills are important for success in this remote role.

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 Overnight Remote Utilization Review jobs in California?

For Overnight Remote Utilization Review jobs in California, the most frequently searched job titles are:

What job categories do people searching Overnight Remote Utilization Review jobs in California look for?

The top searched job categories for Overnight Remote Utilization Review jobs in California are:

What cities in California are hiring for Overnight Remote Utilization Review jobs?

Cities in California with the most Overnight Remote Utilization Review job openings:

Overnight Remote Utilization Review jobs near you
Infographic showing various Overnight Remote Utilization Review job openings in California as of August 2026, with employment types broken down into 88% Full Time, 6% Part Time, and 6% Contract. Highlights an 100% Remote job distribution.

Utilization Review Technician III

Prime Healthcare Management Inc

Ontario, CA • On-site, Remote

$24.65 - $30.03/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 29 days ago

Prime Healthcare rating

6.4

Company rating: 6.4 out of 10

Based on 283 frontline employees who took The Breakroom Quiz

642nd of 887 rated healthcare providers

Job description

Overview

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation's leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team! 

Responsibilities

The Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. This position will also serve as a liaison and own the coordination with other UR techs in the team while being responsible for coordinating phone calls, data entry, mailing/faxing appeals and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals. Document and track all communication attempts with insurance providers and health plans and scan all related correspondence to the respective EMR/ tracking tool. Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers. The Utilization review tech will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned. UR tech III will also function as an SME to support the UR tech team and remote counter parts with the specific processes as applicable. The Utilization review tech will further support the department needs for Release of Information through faxing and mailing, discharge coordination or other duties as assigned.

Qualifications
  • Bachelor's degree or four years of relevant experience required.
  • Microsoft office proficiency.
  • Good communication skills

    • Preferred qualifications:

  • Completion of a medical terminology course; preferred.
  • Knowledge of HIPAA regulations preferred.
    • Pay Transparency

    Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $24.65 to $30.03. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

    Employment StatusFull TimeShiftDaysEqual Employment Opportunity

    Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

     Privacy Notice

    Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf

    Employment Type: FULL_TIME

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