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Remote Utilization Management Jobs in California

Avispa Technology

Application Analyst

Los Angeles, CA · On-site +1

$85/hr

Leading medical institution (Los Angeles, CA 90024 - Remote: Open to candidates located in the ... Management (CRM), and Utilization Management (UM) functions. This role is responsible for ...

Astrana Health

UM Review Nurse

Monterey Park, CA · Remote

$34 - $42/hr

This is a remote position for CA-licensed nurses. Candidates must live in California. We are seeking nurses with at least one year of outpatient Utilization Management experience in a fast-paced ...

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Astrana Health, Inc.

UM Review Nurse

Monterey Park, CA · On-site +1

$34 - $42/hr

This is a remote position for CA-licensed nurses. Candidates must live in California. We are seeking nurses with at least one year of outpatient Utilization Management experience in a fast-paced ...

Astrana Health, Inc.

$250K - $325K/yr

Collaborate with Population Health, Utilization Management, and Post‑Acute teams to reduce ... While this is a Remote - US Based position, this MD will need to reside SoCal to travel to ...

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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 16, 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
Utilization Review Technician III

Utilization Review Technician III

Prime Healthcare Management Inc

Ontario, CA • On-site, Remote

$23.15 - $30.03/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 29 days ago

Prime Healthcare rating

6.3

Company rating: 6.3 out of 10

Based on 270 frontline employees who took The Breakroom Quiz

665th of 872 rated healthcare providers

Job description

Overview

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation's leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team! 

Responsibilities

The Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. This position will also serve as a liaison and own the coordination with other UR techs in the team while being responsible for coordinating phone calls, data entry, mailing/faxing appeals and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals. Document and track all communication attempts with insurance providers and health plans and scan all related correspondence to the respective EMR/ tracking tool. Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers. The Utilization review tech will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned. UR tech III will also function as an SME to support the UR tech team and remote counter parts with the specific processes as applicable. The Utilization review tech will further support the department needs for Release of Information through faxing and mailing, discharge coordination or other duties as assigned.

Qualifications
  • Bachelor's degree or four years of relevant experience required.
  • Microsoft office proficiency.
  • Good communication skills

    • Preferred qualifications:

  • Completion of a medical terminology course; preferred.
  • Knowledge of HIPAA regulations preferred.
    • Pay Transparency

    Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $23.15 to $30.03. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

    Employment StatusFull TimeShiftDaysEqual Employment Opportunity

    Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

     Privacy Notice

    Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf

    Employment Type: FULL_TIME

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