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Remote Supervisor Utilization Management Jobs in California

LIBERTY DENTAL

$150K - $165K/yr

In this fully remote position, you'll use your clinical judgment to review claims and prior ... What You'll Do Utilization Management & Clinical Review * Review dental claims and prior ...

HJ Staffing

QNXT Program Manager

Long Beach, CA · On-site +1

Long Beach, CA (100% Remote) Schedule: Monday - Friday, 8:00 AM - 5:00 PM (PST) Start Date: 08/10 ... Coordinate alignment across Claims, Provider Data, Benefits, Utilization Management, and Capitation ...

Zócalo Health

RN Case Manager

Los Angeles, CA · Remote

$85K/yr

... utilization management, transitions of care, and chronic disease management. * Excellent communication and relationship-building skills. * Ability to work effectively in interdisciplinary and remote ...

Health Link

Remote Workforce Manager

Walnut Creek, CA · Remote

$31 - $37/hr

Monitor employee time, utilization, work output, system activity, work queues, calls, documentation ... Demonstrated experience supervising employees, coordinating schedules, monitoring performance ...

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Remote Supervisor Utilization Management information

What is the difference between Remote Supervisor Utilization Management vs Remote Utilization Review Nurse?

AspectRemote Supervisor Utilization ManagementRemote Utilization Review Nurse
CredentialsRN, often with management or supervisor certificationsRN, with clinical review certifications
Work EnvironmentSupervises teams, manages utilization processes remotelyPerforms clinical reviews, assesses patient necessity remotely
Employer & Industry UsageHealth insurance companies, managed care organizationsInsurance companies, third-party administrators
Primary FocusOverseeing utilization management operationsConducting clinical utilization reviews

Remote Supervisor Utilization Management roles focus on overseeing utilization management teams and processes, ensuring compliance and efficiency. In contrast, Remote Utilization Review Nurses primarily perform clinical assessments to determine the necessity of services. Both roles require RN credentials but differ in responsibilities and scope within the utilization management field.

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The most popular types of Supervisor Utilization Management jobs in California are:

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Remote Supervisor Utilization Management jobs near you

Inpatient Medical Director (SoCal)

Astrana Health, Inc.

Orange, CA • Remote

Full-time

Re-posted 13 days ago

Job description

Description
About the Role
The Inpatient Medical Director provides physician leadership across Astrana Health’s hospital partners, ensuring high‑quality, cost‑effective inpatient care aligned with Astrana’s value‑based and population health strategies. This leader partners closely with hospitalists, specialists, care management, and health plan counterparts to drive clinical excellence, utilization management, and continuity of care across the inpatient–post‑acute continuum.

What You'll Do
  • Serve as physician leader for inpatient clinical operations across assigned hospitals.
  • Drive quality, safety, and patient outcomes aligned with Astrana Health’s value‑based and capitated risk programs.
  • Partner with hospitalists, specialists, nursing leadership, and case management to optimize LOS, avoidable utilization, and transitions of care.
  • Oversee physician performance, clinical compliance, and adherence to evidence‑based protocols and pathways.
  • Collaborate with Population Health, Utilization Management, and Post‑Acute teams to reduce readmissions and total cost of care.
  • Support payer and delegated risk requirements, including clinical documentation, medical necessity, and audits.
  • Act as clinical liaison between Astrana Health, hospital partners, and community physicians.
What Success Looks Like
  • Improved inpatient quality and safety metrics.
  • Reduced LOS, readmissions, and unnecessary utilization.
  • Strong physician engagement and alignment with Astrana Health’s clinical and financial goals.
  • Seamless care transitions across the continuum.

Qualifications
  • Medical Degree (MD or DO) from an accredited institution; active and unrestricted medical license in CA.
  • 5+ years of inpatient clinical experience; prior physician leadership.
  • Experience in value‑based care, risk‑bearing models, or delegated health plan environments.
  • Strong working knowledge of utilization management, quality metrics, and hospital operations.
  • Proven ability to lead, influence, and collaborate across multidisciplinary teams.
  • 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
  • While this is a Remote - US Based position, this MD will need to reside SoCal to travel to inpatient, post-acute facilities, physician groups, ASC, and Health Plans.
  • The national target pay range for this role is $250,000 - $325,000. Actual compensation will be determined based on geographic location (current or future), experience, and 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.