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Remote Rn Case Review Jobs in California (NOW HIRING)

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Remote Rn Case Review information

What is the difference between Remote Rn Case Review vs Remote Rn Utilization Review?

AspectRemote Rn Case ReviewRemote Rn Utilization Review
CredentialsRegistered Nurse (RN), licensure, case review certificationsRegistered Nurse (RN), licensure, utilization review certifications
Work EnvironmentRemote, healthcare settings, insurance companiesRemote, healthcare settings, insurance companies
Employer & IndustryHospitals, insurance firms, healthcare providersInsurance companies, healthcare management organizations

Remote Rn Case Review and Remote Rn Utilization Review roles both involve remote nursing work within the healthcare and insurance industries. While they share similar credentials and work environments, case review focuses on evaluating individual patient cases, whereas utilization review assesses the necessity and appropriateness of healthcare services. Understanding these distinctions helps job seekers identify the right role based on their skills and career goals.

What are the most commonly searched types of Rn Case Review jobs in California? The most popular types of Rn Case Review jobs in California are:
What are popular job titles related to Remote Rn Case Review jobs in California? For Remote Rn Case Review jobs in California, the most frequently searched job titles are:
What job categories do people searching Remote Rn Case Review jobs in California look for? The top searched job categories for Remote Rn Case Review jobs in California are:
What cities in California are hiring for Remote Rn Case Review jobs? Cities in California with the most Remote Rn Case Review job openings:
Remote Rn Case Review jobs near you
Infographic showing various Remote Rn Case Review job openings in California as of May 2026, with employment types broken down into 7% As Needed, 65% Full Time, 7% Part Time, and 21% Contract. Highlights an 100% Remote job distribution.
Clinical Review Nurse

Clinical Review Nurse

A-Line Staffing Solutions

Alameda, CA • Remote

$66/hr

Full-time

Posted 23 days ago

Job description

Clinical Review Nurse

Location: Alameda, CA
Pay: $66.00/hour
Schedule: Full-Time, Monday–Friday, 8:00 AM–5:00 PM
License Required: Active California RN License

Hiring Clinical Review Nurses in Alameda, CA

We are hiring a Clinical Review Nurse in Alameda, California for a full-time opportunity focused on appeals, grievances, medical necessity review, utilization review, and managed care clinical case evaluation. This role is ideal for an experienced Registered Nurse with strong knowledge of clinical documentation review, regulatory turnaround requirements, and health plan or managed care processes.

The Clinical Review Nurse will review complex clinical cases, assess medical records, apply established guidelines, and prepare recommendations related to appeals, grievances, and provider disputes. This role also supports timely case resolution, quality review, and written clinical determinations.

Clinical Review Nurse Responsibilities

  • Review and investigate member and provider appeals and grievances
  • Evaluate prospective, inpatient, and retrospective medical records for medical necessity
  • Apply clinical guidelines, internal policies, and benefit criteria to case review
  • Summarize clinical findings for leadership or physician review
  • Prepare recommendations to uphold or overturn determinations
  • Ensure cases are resolved within required regulatory timeframes
  • Document case activity accurately in tracking systems
  • Draft written correspondence for providers, members, and regulatory entities
  • Identify quality of care concerns and escalate appropriately
  • Serve as a subject matter resource for appeals, grievances, disputes, and quality issues
  • Support reporting, case analysis, and additional clinical review projects as needed

Clinical Review Nurse Requirements

  • Active and unrestricted California Registered Nurse license
  • At least 3 years of acute care clinical experience
  • At least 2 years of appeals and grievances experience
  • Bachelor's degree preferred
  • Experience in utilization management or quality management preferred
  • Experience using clinical review guidelines preferred
  • Knowledge of MCG, managed care, and NCQA preferred
  • Strong clinical judgment and critical thinking skills
  • Strong written communication and documentation skills
  • Ability to manage complex clinical cases and meet deadlines

Preferred Background for a Clinical Review Nurse

Candidates with experience in the following areas are strongly encouraged to apply:

  • Clinical Review
  • Appeals and Grievances
  • Utilization Review
  • Managed Care
  • Quality Management
  • Case Review
  • Medical Necessity Review
  • Regulatory and compliance-driven clinical review

Top Skills for This Clinical Review Nurse Role

  • Clinical review
  • Appeals and grievances
  • Medical necessity review
  • Utilization management
  • Managed care
  • Quality management
  • Case investigation
  • Clinical documentation review
  • Regulatory compliance
  • MCG guidelines
  • NCQA
  • Written determinations

Apply for Clinical Review Nurse Jobs in Alameda, CA

If you are a California RN with experience in appeals, grievances, utilization review, managed care, or quality-based clinical review, this Clinical Review Nurse opportunity may be an excellent fit.

A-Line Staffing Solutions logo

About A-Line Staffing Solutions

Sourced by ZipRecruiter

A-Line Staffing Solutions is an established full-service recruiting and staffing provider that operates in the industry of human resources and recruitment. Based in Utica, Michigan, A-Line Staffing Solutions has been committed to its mission of providing innovative and effective workforce solutions since its foundation. The company specializes in providing high-quality staffing solutions for a range of disciplines, including Information Technology, Professional, Administrative, Healthcare, and more. A-Line prides itself on its ability to offer comprehensive and tailored staffing solutions in line with the varying needs of different businesses, which has played a crucial role in the company's growth and success.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Utica, MI, US

Year founded

2004

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