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Remote Utilization Management Jobs in California

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Remote Utilization Management information

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$41

$68

How much do remote utilization management jobs pay per hour?

As of Jul 26, 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
Infographic showing various Remote Utilization Management job openings in California as of July 2026, with employment types broken down into 2% As Needed, 89% Full Time, 5% Part Time, and 4% Contract. Highlights an 100% Remote job distribution, with an average salary of $86,795 per year, or $41.7 per hour.

Utilization Management RN

Dignity Health Management Services

Bakersfield, CA • Remote

$57.37 - $85.33/hr

Full-time

Posted 6 days ago

Job description


Job Summary and Responsibilities

As our UM RN (Utilization Management Registered Nurse), you will be responsible for ensuring the integrity of the adverse determination processes and accuracy of clinical decision-making, as it relates to the application of criteria and composition of compliant denial notices, to review medical records, authorize requested services, and prepare cases for physician review based on medical necessity.
Every day you will partner with both the Pre-Service and In-Patient Utilization Management teams. You will ensure to monitor and assure the appropriateness and medical necessity of care as it relates to quality, continuity, and cost-effectiveness. This involves meticulous review of medical records, application of clinical guidelines, and collaborative communication to facilitate optimal patient care while ensuring compliance and fiscal responsibility.
To be successful in your role, you will strategically ensure the integrity and accuracy of utilization management decisions, meticulously reviewing medical records and applying clinical criteria to determine medical necessity. You will demonstrate exceptional clinical judgment, partner effectively with pre-service and in-patient teams, and maintain rigorous oversight of care appropriateness, quality, continuity, and cost-effectiveness, thereby safeguarding both patient well-being and organizational resources.

As a remote employee, we will provide you with the equipment needed to work from home, including a laptop, docking station, dual monitors, and accessories.

This position is remote with a CA RN license.  PST business hours will be expected.

Potential for on-call, weekend and holiday shifts.

  • Reviews designated requests for referral authorizations either proactively, concurrently or retroactively. Gathering all information needed to make a determination and/or coordinate with the Medical Director as needed.
  • Ensure compliance with turnaround times and accuracy standards are met.
  • Ensure contracted providers are in place when authorizing.
  • Responsible to coordinate with contracting to obtain appropriate contracts as deemed appropriate.
  • Identify cases that require additional case management.
  • Work with appropriate departments and internal staff to coordinate patient care
Job Requirements

Required

  • Three (3) years recent clinical experience
  • Graduate of an accredited RN program
  • Clear and current CA Registered Nurse (RN) license
  • Knowledge of nursing theory and ability to apply or modify as appropriate
  • Knowledge of ICD-10, CPT, HCPCS coding, medical terminology and insurance benefits
  • Knowledge of legal and ethical considerations related to patient information, PHI and HIPPA regulations


Preferred

  • Bachelors of Nursing (BSN) preferred
  • Previous inpatient Utilization Management (UM) experience strongly preferred
  • Experience with MCG strongly preferred
  • EZCap experience a plus
Where You'll Work

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health's Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

One Community. One Mission. One California 

Qualifications:

Required

  • Three (3) years recent clinical experience
  • Graduate of an accredited RN program
  • Clear and current CA Registered Nurse (RN) license
  • Knowledge of nursing theory and ability to apply or modify as appropriate
  • Knowledge of ICD-10, CPT, HCPCS coding, medical terminology and insurance benefits
  • Knowledge of legal and ethical considerations related to patient information, PHI and HIPPA regulations


Preferred

  • Bachelors of Nursing (BSN) preferred
  • Previous inpatient Utilization Management (UM) experience strongly preferred
  • Experience with MCG strongly preferred
  • EZCap experience a plus
Employment Type: Full Time

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