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Remote Utilization Management Jobs in Orange, CA

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 ...

Centene

Psychologist Reviewer

La Palma, CA · Remote

$87K - $157K/yr

... utilization management processes * Interact with the Medical Director, or designee, to discuss ... with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an ...

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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.

Technical Customer Success Manager

COPE Health Solutions

Los Angeles, CA • Remote

$139K - $175K/yr

Full-time

Posted 23 days ago

Job description

The Technical Customer Success Managerplays a pivotal role in bridging technical expertise and customer-facing outcomes. This position focuses on empowering the sales team with compelling demonstrations and use case presentations while ensuring newly signed clients achieve their goals during implementation. Collaborating closely with key stakeholders across engineering, product, finance, and clinical leadership, this role ensures the SaaS platform evolves to meet customer needs and supports organizational growth.

FLSA Status

Exempt

Salary Range

$139,000 - $175,400

Reports To

Director, Customer Success and Technical Solutions

Direct Reports

No

Location

Los Angeles, or remote with travel

Travel

Up to 40% , depending on location

Work Type

Regular

Schedule

Full Time

Position Description

  • Lead technical implementation and data integration for newly onboarded clients, configuring health plan, MSO, and delegated IPA data feeds including claims, eligibility, HIE, and clinical data into the ARC platform
  • Design, build, and troubleshoot data mapping, ETL/integration workflows, and data validation processes to ensure accurate, complete, and timely data flow into ARC and its downstream Care Management, Utilization Management, Analytics, and Provider applications
  • Support both internal and external client relationships to ensure adoption, retention, and expansion of the ARC platform, including training on platforms and resolving integration challenges.
  • Provide hands-on technical guidance, such as designing workflows for data aggregation, analytics tools, and tech capabilities to support clinical and financial goals
  • Act as a strategic advisor for clients, troubleshooting data integrations and architecting solutions to enhance value-based care outcomes
  • Monitor industry trends in healthcare tech to ensuresuccess, engineering, product, and sales teams.
  • Develop and articulate strategic recommendations aligned with client goals related to quality performance, cost management, and financial sustainability.
  • Partner with analytics, finance, clinical and actuarial resources to assess cost drivers, risk adjustment performance, and quality outcomes.
  • Build strong relationships with client leadership, serving as a trusted advisor throughout the engagement lifecycle.
  • Contribute to thought leadership through development of articles, case studies, implementation playbooks, internal curricula, and client-facing content.

Qualifications:

  • Master's degree in an applicable field preferred (e.g., MBA, MPH, MHA, MPA)
  • At least 5 years of health care analytics and/or consulting experience of progressively advanced reports, data management and visualization experience.
  • Knowledge of the data sources needed to run MSO services for health plans and delegated IPAs, Shared Savings Arrangements, and CMS ACO models including claims, eligibility, utilization, HIE, and clinical data
  • Understanding of how this data maps to and supports Care Management (CM), Utilization Management (UM), Analytics, and Provider applications at the point of care
  • Proven experience in SaaS platform support, implementation, or technical account management, with a strong understanding of software architecture and delivery.
  • Exceptional communication and presentation skills, with the ability to distill complex technical concepts for non-technical audiences, including sales teams and clients.
  • Experience collaborating with cross-functional teams, including sales, engineering, product, finance, and clinical stakeholders.
  • Prior experience in:
    • Population health management reporting and analytics
    • Health information technology
    • Health care policy with experience in CMS, Medicare, and Medicaid contracts
    • Healthcare claims data and clinical data integration (EMR, HIE, etc.)
  • Strong project management skills, including organization, prioritization, and problem-solving skills; strong oral, verbal and interpersonal communication skills. Ability to take direction and feedback from both internal and external stakeholders.
  • Ability to work effectively on multiple projects in a fast-paced environment

Benefits:

As a firm passionate about health care, we're deeply committed to the health and wellness of our own team members. We offer comprehensive, affordable insurance plans for our team and their families, and a host of other unique benefits, such as a yearly stipend for wellness-related activities and a paid parental leave program. You can learn more about our benefits offerings here: https://copehealthsolutions.com/careers/why-cope-health-solutions/.
About COPE Health Solutions
COPE Health Solutions is a national tech-enabled services firm powering success for health plans and for providers in risk arrangements. Our comprehensive NCQA certified population health management platform and highly experienced team brings deep expertise, experience, proven tools, and processes to improve financial performance and quality outcomes for all types of payers and providers. CHS de-risks the roadmap to advanced value-based payment and improves quality and financial performance for providers, health plans and self-insured employers. For more information, visit CopeHealthSolutions.com.
To Apply:

To apply for this position or for more information about COPE Health Solutions, visit us at https://copehealthsolutions.com/careers/open-positions/.

Employment Type: Full-Time

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