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Remote Utilization Management Jobs in Orange, CA

HJ Staffing

QNXT Program Manager (Remote)

Long Beach, CA · Remote

Long Beach, CA (100% Remote) Schedule: Monday Friday, 8:00 AM 5:00 PM (PST) Start Date: 08/10/2026 ... Coordinate alignment across Claims, Provider Data, Benefits, Utilization Management, and Capitation ...

KTI Health

Be Seen First

Registered Nurse Utilization Review - Remote

Torrance, CA · Remote

$2.1K - $2.2K/wk

Remote Travel/Contract Contract: 13 weeks Start Date: September 21, 2026 Pay: $55/hour & $2200 ... Utilization Review / Case Management experience preferred * Must be available for the assigned PST ...

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 ...

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All JobsUtilization Management JobsRemote Utilization Management JobsRemote Utilization Management Jobs in Orange, CA

Remote Utilization Management information

See Orange, CA salary details

$22

$45

$73

How much do remote utilization management jobs pay per hour?

As of Sep 3, 2026, the average hourly pay for remote utilization management in Orange, CA is $45.17, according to ZipRecruiter salary data. Most workers in this role earn between $35.67 and $51.88 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 popular job titles related to Remote Utilization Management jobs in Orange, CA?

For Remote Utilization Management jobs in Orange, CA, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Management jobs in Orange, CA look for?

The top searched job categories for Remote Utilization Management jobs in Orange, CA are:

What cities near Orange, CA are hiring for Remote Utilization Management jobs?

Cities near Orange, CA with the most Remote Utilization Management job openings:

Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Orange, CA as of August 2026, with employment types broken down into 1% As Needed, 86% Full Time, 11% Part Time, and 2% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $93,950 per year, or $45.2 per hour.

Remote: Utilization Review Specialist

Treatment Center Management LLC

Los Angeles, CA • Remote

$80K - $90K/yr

Full-time

Medical, Dental, Vision, Life, PTO

Posted 3 days ago

New

Job description

Be part of a soul-hearted approach to healing

Alsana is a national leader in eating disorder treatment, offering a holistic, soul-hearted approach to recovery for adults and adolescents of all genders.

We exist to be a source of hope and healing, creating safe, nurturing spaces where individuals can cultivate the roots of their own recovery story.

As a Utilization Review Specialist at Alsana, you will support utilization management activities including medical necessity reviews, clinical documentation, and patient status determination. You will work closely with clinical teams and leadership to help ensure appropriate levels of care, accurate documentation, and compliance with payer and regulatory requirements.

Key Responsibilities
  • Perform utilization review, including preauthorization, concurrent, and retrospective reviews for inpatient and/or outpatient services.
  • Maintain current knowledge of payer requirements, LOCUS criteria, regulatory standards, accreditation expectations, and evidencebased documentation practices.
  • Use clinical expertise and payer knowledge to act as a liaison to treatment team members through ongoing communication.
  • Attend weekly Treatment Team Meetings, providing updates on new authorizations and atrisk cases.
  • Maintain timely, accurate records of review determinations, information requests, and recommendations within the electronic medical record (EMR).
  • Inspect documentation to confirm compliance with payer requirements, regulatory standards, accreditation expectations, and evidencebased documentation practices.
  • Assist with appeals, denials management, and corrective actions related to utilization review findings.
  • Participate in case conferences and provide training and education related to documentation standards and utilization review.
    • Qualifications
  • One or more of the following credentials: LPC, LCSW, LMFT, RD, RN, LVN, LPN, or PsyD
  • Experience in utilization review or case management preferred
  • Experience in a business/corporate setting or similar environment preferred
  • Experience in eating disorders preferred
    • Benefits That Support You

    At Alsana, we believe in caring for the people who make our mission possible. Eligible team members enjoy a supportive benefits package designed to support your health, well-being, and growth, including:

  • Medical, Dental, and Vision insurance with multiple plan options

    • (Cigna nationwide; Kaiser available in CA)

  • HSA plans with employer contributions
  • FSA Healthcare and Dependent Care plan options
  • Generous PTO, sick time, Covid Time, and 6 paid holidays
  • Companypaid Basic Life and AD&D insurance
  • Shortterm disability (companypaid for nonCA; CA uses state plan)
  • Continuing education stipend for eligible roles
  • Voluntary benefits including Supplemental Life, LongTerm Disability, Accident, and Hospital Indemnity
  • LifeMart employee discount program

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