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Remote Utilization Management Jobs in California

Pharmacy Careers

Appeals Pharmacist (Remote)

Pacoima, CA · On-site +1

$59 - $71.75/hr

Prior managed care or utilization management experience preferred - retail and hospital pharmacists ... Many roles offer hybrid or fully remote options. * Rewards: Competitive salary, comprehensive ...

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All JobsRemote Utilization Management JobsRemote Utilization Management Jobs in California

Remote Utilization Management information

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$21

$41

$68

How much do remote utilization management jobs pay per hour?

As of Jun 12, 2026, the average hourly pay for remote utilization management in California is $41.73, according to ZipRecruiter salary data. Most workers in this role earn between $32.98 and $47.93 per hour, depending on experience, location, and employer.

How does a Remote Utilization Management professional typically collaborate with healthcare providers and insurance teams?

Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.

What are the key skills and qualifications needed to thrive as a Remote Utilization Management Nurse, and why are they important?

Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.

What is remote utilization management?

Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.

What is the difference between Remote Utilization Management vs Remote Case Management?

AspectRemote Utilization ManagementRemote Case Management
CredentialsRN, LPN, or licensed healthcare professionalsRN, LPN, or social workers
Work EnvironmentHealthcare facilities, insurance companies, telehealthHealthcare providers, insurance, community agencies
Industry UsageInsurance, healthcare, telehealthHealthcare, social services, insurance
Primary FocusReviewing medical necessity, authorizationsCoordinating patient care, support services

Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.

What are the most commonly searched types of Utilization Management jobs in California? The most popular types of Utilization Management jobs in California are:
What are popular job titles related to Remote Utilization Management jobs in California? For Remote Utilization Management jobs in California, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management jobs in California look for? The top searched job categories for Remote Utilization Management jobs in California are:
What cities in California are hiring for Remote Utilization Management jobs? Cities in California with the most Remote Utilization Management job openings:
Remote Utilization Management jobs near you

Medical Director - Utilization Management (Part Time)

Astrana Health, Inc.

Monterey Park, CA • On-site, Remote

$250K - $325K/yr

Part-time

Posted 24 days ago

Job description

Medical Director - Utilization Management (Part Time)
Department: HS - UM
Employment Type: Part Time
Location: 1600 Corporate Center Dr., Monterey Park, CA 91754
Reporting To: Dr. Dinesh Kumar
Description
About the Role
The Part‑Time Medical Director - Utilization Management, Outpatient Services provides physician oversight for medical necessity, appropriateness, and utilization decisions across Astrana Health's outpatient, ancillary, and professional services. This role supports Astrana's delegated risk arrangements by ensuring compliant, evidence‑based utilization while partnering closely with outpatient clinical leadership, UM operations, and health plan stakeholders.
What You'll Do
  • Provide physician oversight and final determination for outpatient utilization management activities, including prior authorizations, retrospective reviews, and appeals.
  • Ensure medical necessity and appropriateness of outpatient services such as specialty referrals, diagnostics, imaging, DME, therapies, and procedures.
  • Support compliance with delegated health plan requirements, regulatory standards, and accreditation guidelines.
  • Conduct peer‑to‑peer reviews and outpatient physician education to improve documentation, guideline adherence, and appropriate utilization.
  • Partner with Outpatient Medical Directors, Population Health, and UM nursing teams to align utilization decisions with Astrana's value‑based care strategy.
  • Identify outpatient utilization trends, leakage, and variation; recommend clinical strategies to improve cost efficiency and quality outcomes.
  • Serve as clinical liaison with health plans and external vendors on outpatient UM‑related matters.

Qualifications
  • MD or DO; Board Certified in Internal Medicine, Family Medicine, or a relevant outpatient specialty required.
  • Active, unrestricted medical license (California required).
  • Prior experience in outpatient utilization management, health plan medical management, or delegated risk environments.
  • Strong understanding of outpatient medical necessity criteria, prior authorization workflows, and appeals processes.
  • Experience working with PCPs and ambulatory specialists in value‑based care models.
  • Strong physician‑to‑physician communication and clinical judgment.

Environmental Job Requirements and Working Conditions
  • This is a Remote - US based position.
  • The national target base salary range for this role is: $250,000 - $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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