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Remote Insurance 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 ...

Corvel

UR Intake Specialist

Rancho Cucamonga, CA · Remote

$16.90 - $26.92/hr

... Utilization Review / Case Management department, and of CorVel. This is a remote position ... Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and ...

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Remote Insurance Utilization Review information

What is the difference between Remote Insurance Utilization Review vs Remote Claims Reviewer?

AspectRemote Insurance Utilization ReviewRemote Claims Reviewer
CredentialsTypically requires nursing or healthcare-related certifications, such as RN or licensed healthcare professionalUsually requires insurance or claims processing knowledge, sometimes with certifications like CPC or CPC-H
Work EnvironmentRemote, healthcare or insurance company settings, reviewing medical necessity and appropriateness of servicesRemote, insurance companies or third-party administrators, reviewing claims for accuracy and compliance
Industry UsageCommonly used in healthcare insurance to evaluate medical necessityUsed across insurance sectors to process and validate claims

Remote Insurance Utilization Review focuses on assessing the medical necessity of services, often requiring healthcare credentials. Remote Claims Reviewers handle claims processing and validation, emphasizing insurance knowledge. Both roles are remote and industry-specific but differ in their primary responsibilities and required qualifications.

How does a remote insurance utilization review professional collaborate with healthcare providers and insurance companies?

Remote insurance utilization review professionals regularly interact with healthcare providers to gather patient information, clarify treatment plans, and ensure that clinical documentation supports insurance requirements. They also communicate with insurance companies to advocate for patient care, provide necessary justifications, and resolve coverage issues. While the work is done remotely, collaboration typically occurs via secure email, phone calls, and virtual meetings, requiring strong communication and organizational skills to ensure timely and accurate exchange of information.

What are remote insurance utilization review jobs?

Remote insurance utilization review jobs involve evaluating medical records and treatment plans to determine whether healthcare services are medically necessary and covered by a patient’s insurance plan. Professionals in these roles, often nurses or other healthcare specialists, work from home and communicate with healthcare providers, insurance companies, and patients. Their main goal is to ensure that patients receive appropriate care while also helping insurance companies manage costs and comply with regulations.

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

To thrive as a Remote Insurance Utilization Review Specialist, you need a strong understanding of medical terminology, clinical guidelines, and insurance policies—usually supported by a nursing or health-related degree and relevant licensure. Familiarity with electronic medical record (EMR) systems, insurance claims platforms, and utilization review software is essential. Strong analytical skills, attention to detail, and effective written communication are crucial soft skills for this role. These competencies ensure accurate case evaluations, compliance with regulations, and clear communication between healthcare providers and insurers.
What are the most commonly searched types of Insurance Utilization Review jobs in California? The most popular types of Insurance Utilization Review jobs in California are:
What are popular job titles related to Remote Insurance Utilization Review jobs in California? For Remote Insurance Utilization Review jobs in California, the most frequently searched job titles are:
What job categories do people searching Remote Insurance Utilization Review jobs in California look for? The top searched job categories for Remote Insurance Utilization Review jobs in California are:
What cities in California are hiring for Remote Insurance Utilization Review jobs? Cities in California with the most Remote Insurance Utilization Review job openings:
Remote Insurance Utilization Review jobs near you
Utilization Management Manager, Medicare Advantage - RN

Utilization Management Manager, Medicare Advantage - RN

University of California

Los Angeles, CA • Hybrid

$116K - $264K/yr

Other

Posted 27 days ago

University Of California rating

8.5

Company rating: 8.5 out of 10

Based on 33 frontline employees who took The Breakroom Quiz

65th of 536 rated colleges and universities

Job description

Manager For Medicare Advantage Utilization Management

Take on a high-impact role within a world-class health organization. Help drive the continued delivery of exceptional patient care. Take your career to the next level. You can do all this and more at UCLA Health.

Work Location: Los Angeles, CA, USA

Onsite or remote flexible hybrid work schedule Monday - Friday, 8:00am - 5:00pm PST, including some weekends

Salary Range: $116,300 - $264,600 Annually

Employment Type 2 - Staff: Career Duration Indefinite Job # 20670

As a Manager for Medicare Advantage Utilization Management, you'll provide direct management to a team of UM coordinators and nurses. You'll work closely with Medicare Advantage leadership to plan, execute, and manage various initiatives related to UM administrative, operational, and strategic objectives. You'll demonstrate leadership and effective communication by fostering collaborative relationships with peers, co-workers, and staff. You'll be responsible for overseeing and coordinating the following major functions:

  • Pre-service Authorizations/Denial Letters
  • Concurrent Review
  • Continuity of Care
  • Retro Claims
  • Retrospective Review
  • Referral Automation Business Rules/Configuration

Bachelors of Science, Nursing (BSN) degree required

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