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Remote Prior Authorization Rn Jobs in Long Beach, CA

Astrana Health, Inc.

UM Review Nurse

Monterey Park, CA · Remote

$34 - $47/hr

This is a remote position for CA-licensed nurses. Candidates must live in California. We are ... Complete prior authorization/retrospective review of elective inpatient admissions, outpatient ...

Astrana Health

UM Review Nurse

Monterey Park, CA · Remote

$34 - $47/hr

This is a remote position for CA-licensed nurses. Candidates must live in California. We are ... Complete prior authorization/retrospective review of elective inpatient admissions, outpatient ...

Astrana Health, Inc.

UM Review Nurse

Monterey Park, CA · On-site +1

$34 - $47/hr

This is a remote position for CA-licensed nurses. Candidates must live in California. We are ... Complete prior authorization/retrospective review of elective inpatient admissions, outpatient ...

Imh

RN Care Manager

West Covina, CA · Remote

$41.20 - $62.17/hr

The RN Hospital Care Manager I delivers comprehensive care management services to designated ... If applying for a remote or hybrid role, this includes remote work expectations related to ...

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Showing results 21-40

All JobsPrior Authorization Rn JobsRemote Prior Authorization Rn JobsRemote Prior Authorization Rn Jobs in Long Beach, CA

Remote Prior Authorization Rn information

See Long Beach, CA salary details

$7

$44

$75

How much do remote prior authorization rn jobs pay per hour?

As of Aug 11, 2026, the average hourly pay for remote prior authorization rn in Long Beach, CA is $44.42, according to ZipRecruiter salary data. Most workers in this role earn between $33.12 and $52.60 per hour, depending on experience, location, and employer.

What is the difference between Remote Prior Authorization Rn vs Remote Medical Coder?

AspectRemote Prior Authorization RnRemote Medical Coder
CredentialsRN license, certification in case management or utilization reviewCertification in coding (CPC, CCS), high school diploma or equivalent
Work EnvironmentHealthcare facilities, insurance companies, telehealthMedical offices, insurance companies, remote coding platforms
Industry UsageUtilization review, patient authorization, insurance approvalMedical record review, billing, coding for insurance claims

Remote Prior Authorization Rns focus on reviewing patient information to approve treatments, while Remote Medical Coders translate medical records into codes for billing. Both roles require healthcare knowledge but serve different functions within the healthcare industry.

What are popular job titles related to Remote Prior Authorization Rn jobs in Long Beach, CA? For Remote Prior Authorization Rn jobs in Long Beach, CA, the most frequently searched job titles are:
What job categories do people searching Remote Prior Authorization Rn jobs in Long Beach, CA look for? The top searched job categories for Remote Prior Authorization Rn jobs in Long Beach, CA are:
What cities near Long Beach, CA are hiring for Remote Prior Authorization Rn jobs? Cities near Long Beach, CA with the most Remote Prior Authorization Rn job openings:
Remote Prior Authorization Rn jobs near you
Infographic showing various Remote Prior Authorization Rn job openings in Long Beach, CA as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $92,391 per year, or $44.4 per hour.

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

Astrana Health, Inc.

Monterey Park, CA • On-site, Remote

$275K - $325K/yr

Full-time

Posted 26 days ago

Job description

Medical Director - Utilization Management (Full-Time or Part-Time)
Department: HS - UM
Employment Type: Full Time
Location: 1600 Corporate Center Dr., Monterey Park, CA 91754
Reporting To: William Wang
Compensation: $275,000 - $325,000 / year
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.
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
Prior Authorization Management
  • Review and issue timely determinations for prior authorization requests, ensuring medical necessity, regulatory compliance, and alignment with evidence-based clinical guidelines.
  • Collaborate with care management and operational teams to streamline and enhance prior authorization workflows for efficiency and provider satisfaction.
  • Provide clinical leadership in the development, implementation, and regular updating of authorization criteria and policies based on the latest medical standards.
  • Promote transparency by clearly documenting and communicating authorization decisions to providers and members, including rationale and guidance for alternative treatment options when applicable.

Utilization Management
  • Provide oversight for the daily activities of the UM program, ensuring services are delivered appropriately and in accordance with clinical best practices.
  • Analyze utilization data to identify trends, high-cost drivers, and opportunities for care optimization and cost containment.
  • Participate in the clinical review of complex or high-cost cases, offering recommendations rooted in medical necessity and member-centered care.
  • Collaborate with interdisciplinary clinical teams to ensure the appropriate use of healthcare resources without compromising quality.

Quality Assurance and Improvement
  • Ensure all UM activities meet applicable federal, state, and accreditation standards (e.g., CMS, NCQA).
  • Lead and contribute to quality improvement initiatives focused on enhancing the effectiveness, accuracy, and consistency of the prior authorization and UM processes.
  • Conduct audits and peer reviews to validate adherence to guidelines and evaluate the quality of medical decision-making.

Provider and Member Communication
  • Serve as the primary clinical contact for complex medical necessity determinations and escalated provider appeals.
  • Build strong working relationships with providers by offering education and clarity around the prior authorization process and criteria.
  • Support member care continuity by suggesting medically appropriate alternatives when requested services are denied.

Regulatory Compliance and Accreditation
  • Ensure full compliance with all applicable UM regulatory and accreditation standards, including NCQA and CMS requirements.
  • Maintain up-to-date knowledge of evolving healthcare laws, policies, and industry standards affecting prior authorization and UM processes.
  • Lead internal efforts to prepare for and maintain UM-related accreditation, including audits, documentation, and process improvement.

Data Analysis and Reporting
  • Monitor and analyze prior authorization and UM metrics (e.g., denial rates, turnaround times, appeal volumes) to identify performance gaps and track progress.
  • Use data-driven insights to inform strategic decisions, improve process efficiency, and support cost management goals.
  • Provide regular updates and reporting to senior leadership on program performance, cost impact, compliance status, and quality indicators.
  • Other duties across all areas as assigned.

Qualifications
  • Medical Degree (MD or DO) from an accredited institution; active and unrestricted medical license in CA.
  • Board certification (preferred) in a relevant specialty (e.g., Internal Medicine, Family Medicine, or equivalent).
  • At least 5 years of clinical practice experience.
  • At least 3 years of experience in utilization management or medical management within a health plan, IPA/MSO, or risk-bearing organization.
  • Deep knowledge of managed care, value-based care, capitation, and CMS/Medi-Cal guidelines.
  • Proficient in applying MCG, InterQual, or equivalent criteria.
  • Strong understanding of state and federal regulations (e.g., CMS, DMHC, NCQA).
  • Excellent communication skills, including the ability to engage providers in meaningful, respectful clinical dialogue.
  • Highly collaborative mindset with a commitment to improving healthcare equity, quality, and cost-effectiveness.

Environmental Job Requirements and Working Conditions
  • This position is fully remote, with some travel to SoCal required as needed. Candidates must have a CA medical license.
  • We are open to part-time employment for candidates who can commit to 3 full 8-hour shifts per week. We are also open to full-time candidates, M-F 8 A - 5 P PST.
  • 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.

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.

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