ZipRecruiter

Log In

2

Remote 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 ...

WinChoice USA

QNXT Program Manager

Long Beach, CA · Remote

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 ...

previous page

Showing results 41-60

All JobsUtilization Management JobsRemote Utilization Management JobsRemote Utilization Management Jobs in California

Remote Utilization Management information

See California salary details

$21

$41

$68

How much do remote utilization management jobs pay per hour?

As of Sep 5, 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.

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 are the key skills and qualifications needed to thrive in remote utilization management?

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.

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 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 August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 15% Part Time, and 2% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $86,795 per year, or $41.7 per hour.

Staff Dentist

LIBERTY DENTAL

On-site, Remote

$150K - $165K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 15 days ago

Job description

Join Liberty Dental Plan as We Shape the Future of Dental Insurance!
Liberty Dental Plan is looking for a New York Licensed Staff Dentist to join our growing team! Unrestricted license or certification to practice dentistry in the State of New York.
Ready to take your clinical expertise beyond the traditional practice setting? At LIBERTY Dental Plan, our Staff Dentists play a critical role in shaping how quality dental care is delivered at scale.
In this fully remote position, you'll use your clinical judgment to review claims and prior authorizations, helping ensure members receive the right care at the right time. Your work directly influences patient outcomes, supports providers, and strengthens the integrity of dental benefits across Commercial, Marketplace, Medicare Advantage, and Medicaid programs.
This is more than a review role-it's an opportunity to collaborate with experienced clinical leaders, contribute to meaningful quality initiatives, and grow your impact within a mission-driven organization dedicated to improving oral health nationwide.
What You'll Do
Utilization Management & Clinical Review
  • Review dental claims and prior authorization requests, applying coverage guidelines and benefit plan policies to ensure accurate determinations
  • Interpret dental records, radiographs, and clinical documentation to assess medical necessity
  • Meet established productivity and quality benchmarks for clinical reviews
  • Document clear, concise clinical rationale aligned with regulatory and accreditation standards

Calibration & Clinical Consistency
  • Participate in calibration sessions to ensure consistent application of clinical guidelines and policies
  • Complete interrater reliability assessments and meet accuracy benchmarks
  • Raise complex or unclear cases for peer discussion and resolution
  • Incorporate feedback from audits and reviews to continuously improve accuracy

Provider Engagement & Peer Review
  • Conduct peer-to-peer consultations with providers regarding clinical decisions and treatment alternatives
  • Support grievance and appeal reviews with clinical insight
  • Collaborate with dental specialists and internal teams on complex cases

Training, Collaboration & Compliance
  • Participate in clinical trainings and team meetings
  • Partner with Utilization Management, Claims, Dental Directors, and Grievances & Appeals teams
  • Support regulatory reporting and maintain knowledge of applicable standards and guidelines
  • Stay current on ADA coding updates and evidence-based clinical practices
A Day in the Life
In this role, your day is highly focused and structured around clinical review and collaboration:
  • ~90% of your time reviewing prior authorizations and dental claims using internal systems (including AI-supported platforms)
  • Interpreting clinical documentation and applying your judgment to ensure accurate, compliant determinations
  • ~10% of your time participating in calibration sessions, identifying trends (including fraud, waste, and abuse), and supporting workflow improvements

You'll start your day by logging in, reviewing assigned cases, and managing your review queue while maintaining quality and turnaround expectations. You'll also engage with colleagues and providers as needed to support accurate and consistent outcomes.
What You'll Bring
Required Qualifications
  • DDS or DMD from an accredited institution
  • Active, unrestricted New York dental license in good standing (required)
  • Minimum 6 years of experience as a practicing dentist
  • Experience with claims review, utilization management, or quality initiatives preferred

Key Skills & Expertise
  • Strong clinical judgment and ability to evaluate dental necessity and treatment appropriateness
  • Ability to interpret dental radiographs and clinical records
  • Knowledge of managed care systems, reimbursement models, and regulatory requirements
  • Strong written communication skills to document clear and defensible clinical decisions
  • Ability to manage high-volume review work efficiently while maintaining accuracy
  • Comfort working in a remote, structured environment during standard business hours
  • Proficiency with computer systems and ability to learn new technology platforms, including AI-supported tools
Work Environment & Expectations
  • Fully remote position
  • Structured schedule aligned with core business hours (not a flexible-hours role)
  • Highly collaborative environment with cross-functional teams
  • Focus on productivity, accuracy, and quality outcomes
Compensation
  • Salary Range: $150,000 - $165,000 annually
    (Final compensation will depend on experience, qualifications, and licensure.)
Why Join LIBERTY Dental Plan?
At LIBERTY, you'll be part of a mission-driven organization dedicated to improving oral health outcomes through quality, innovation, and collaboration. This role offers the opportunity to apply your clinical expertise in a new way-impacting care at scale while working alongside a supportive and experienced team.
Ready to Apply?
If you are a clinically strong dentist with an active New York license and a passion for improving care quality in a managed care environment, we encourage you to apply today.
Location
Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States.
What Liberty Offers
Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That's why Liberty offers competitive and attractive benefit packages for our employees. We strive to care for employees in ways that promote wellness and productivity.
Our first-class benefits package supports employees and their dependents with:
  • Competitive pay structure and savings options to help you reach your financial goals.
  • Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines.
  • Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan.
  • 100% employer-paid dental coverage for employees and eligible dependents.
  • Vision insurance with low-cost premiums for employee-only coverage and dependents.
  • Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage.
  • Flexible Spending Accounts for healthcare and dependent care expenses.
  • Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance.
  • Long-term disability coverage.
  • Expansive wellness programs, including company-wide wellness challenges, and gym discounts.
  • Employee Assistance Program (EAP) to support mental health and well-being.
  • Generous vacation and sick leave policies, with the ability to roll over unused time.
  • 10 paid company holidays.
  • Tuition reimbursement for eligible educational expenses.
  • Remote or hybrid work options available for various positions.

Compensation
In the spirit of pay transparency, the base salary range for this position is $150,000 - $165,000 annually, not including fringe benefits or potential bonuses. At Liberty, your final base salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our current team members when making final compensation decisions.
Please note that the range listed represents the full base salary range for this role. Typically, offers are not made at the top of the range to allow for future salary growth.
Liberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high performance teams and organizational culture.
Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve.
We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements.
Sponsorship and Relocation Specifications
Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled.
No relocation assistance or sponsorship available at this time.

Apply