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Remote Utilization Review Manager Jobs in Hemet, CA

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Remote Utilization Review Manager information

See Hemet, CA salary details

$39.1K

$91.3K

$168.1K

How much do remote utilization review manager jobs pay per year?

As of Sep 8, 2026, the average yearly pay for remote utilization review manager in Hemet, CA is $91,324.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,700.00 and $109,900.00 per year, depending on experience, location, and employer.

What is a remote utilization review manager?

A Remote Utilization Review Manager is a healthcare professional responsible for overseeing the review of medical services and determining the necessity, appropriateness, and efficiency of those services from a remote location. They ensure that healthcare providers comply with guidelines and that patients receive appropriate care without unnecessary procedures. These managers work with clinical teams, insurance companies, and regulatory agencies to optimize patient outcomes and manage healthcare costs. Working remotely allows them to perform these duties using digital health records and telecommunication tools.

What are the key skills and qualifications needed to thrive as a remote utilization review manager?

To thrive as a Remote Utilization Review Manager, you need expertise in healthcare management, case review, and regulatory compliance, typically supported by a nursing degree (RN or BSN) and relevant certifications such as CCM or URAC. Familiarity with utilization management software, electronic health records (EHRs), and payer systems is essential. Strong analytical thinking, attention to detail, and excellent communication skills help navigate complex cases and collaborate with clinical teams and insurers. These skills ensure effective resource utilization, regulatory adherence, and optimal patient outcomes in a remote healthcare environment.

What are some common challenges faced by a remote utilization review manager, and how can they be addressed?

A Remote Utilization Review Manager often encounters challenges such as maintaining effective communication with clinical teams, ensuring timely and accurate reviews, and staying updated with changing regulations and payer requirements. To address these, it's important to leverage secure collaborative platforms, establish clear workflows, and participate in ongoing training. Building strong relationships with team members and regularly reviewing protocols also help in overcoming remote work hurdles and ensuring compliance and efficiency.

What is the difference between Remote Utilization Review Manager vs Remote Utilization Review Nurse?

AspectRemote Utilization Review ManagerRemote Utilization Review Nurse
CredentialsTypically requires a nursing license, certifications like URAC or AAPC, and management experienceLicensed Registered Nurse (RN) with utilization review certification often preferred
Work EnvironmentOversees review teams, manages processes, and ensures compliance remotelyPerforms case reviews, assesses medical necessity, and documents findings remotely
Employer & Industry UsageHealth insurance companies, third-party administrators, healthcare organizations

The Remote Utilization Review Manager focuses on overseeing review teams and managing processes, while the Remote Utilization Review Nurse conducts case assessments and medical necessity reviews. Both roles require nursing credentials and are integral to healthcare utilization management, but differ in responsibilities and leadership levels.

What are popular job titles related to Remote Utilization Review Manager jobs in Hemet, CA?

For Remote Utilization Review Manager jobs in Hemet, CA, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Manager jobs in Hemet, CA look for?

The top searched job categories for Remote Utilization Review Manager jobs in Hemet, CA are:

What cities near Hemet, CA are hiring for Remote Utilization Review Manager jobs?

Cities near Hemet, CA with the most Remote Utilization Review Manager job openings:

Senior Licensed Clinical Social Worker - Remote Detox Services

Riverside, CA • Remote

$120K - $130K/yr

Full-time

Medical, Retirement, PTO

Posted 6 days ago


Job description

Position Overview

We are seeking a dedicated and experienced Licensed Clinical Social Worker (LCSW) to join our dynamic team at Child and Adult Empower Mental Clinic Services. This full-time, remote position offers an exceptional opportunity to engage with clients within a detoxification center setting, empowering individuals on their journey to recovery and optimal mental health. Targeted at professionals who thrive in a supportive and collaborative environment, this role is pivotal in providing comprehensive case management, community engagement, and individualized care that makes a difference in the lives of our clients.

About the Organization

Child and Adult Empower Mental Clinic Services is committed to delivering exceptional mental health services to both children and adults. Based in Riverside, California, our mission is to uplift and transform lives through a holistic approach to mental well-being. We emphasize the importance of community involvement, offering resources that bridge clients to beneficial local services, ensuring a comprehensive approach to their mental health needs.

Work Environment

This role is fully remote, allowing for a flexible work-life balance while being part of a supportive team focused on client-centered care. Our detox center serves a diverse population, providing care that involves intensive support, monitoring, and treatment for individuals with complex needs. This remote setting fosters a culture of collaboration and problem-solving, utilizing technology to effectively communicate and coordinate care among team members and other departments.

Key Responsibilities
  • Conduct regular wellness checks to monitor client progress and respond to urgent needs, ensuring a proactive approach to mental health care.
  • Adhere strictly to all facility protocols and licensing standards, maintaining compliance with legal and ethical guidelines in clinical practice.
  • Collaborate with fellow clinical team members, providing additional support and coverage as needed to maintain consistent care delivery
  • Engage actively with the Utilization Review Department and Business Department regarding insurance authorization protocols, ensuring that services provided are appropriately authorized and billed.
  • Develop personalized care plans that respect individual client needs, effectively using assessment tools to measure progress and adapt strategies as necessary.
Patient Population / Client Focus

In this role, you will be primarily working with adults experiencing substance use disorders and related mental health challenges. Our clientele often face complex situations requiring sensitive handling and effective treatment strategies. You will utilize your expertise to provide compassionate support, facilitating recovery and empowering clients to regain their agency and improve their quality of life.

Qualifications
  • A Master’s degree in Social Work (MSW) from an accredited institution.
  • Active licensure as a Clinical Social Worker (LCSW) in the state of California.
  • Strong written and verbal communication skills, essential for effective documentation, interaction with clients, and collaboration with team members.
  • Proven ability to establish and maintain appropriate professional boundaries with clients, creating a safe and supportive therapeutic environment.
  • Well-organized with a demonstrated capability to document services and complete reports accurately and in a timely manner.
Preferred Experience
  • Experience in a detox or rehabilitation setting, with a strong understanding of substance use issues.
  • Familiarity with community resources and services that support mental health and recovery.
  • Previous involvement in multidisciplinary teamwork, enhancing holistic care and improving patient outcomes.
Compensation and Benefits
  • Competitive salary ranging from $120,000 to $130,000 annually, commensurate with experience and caseload.
  • Comprehensive benefits package including health insurance, retirement plan contributions, and paid time off.
  • Opportunities for ongoing professional development, including workshops, training sessions, and continuing education programs.
  • A collaborative and supportive work culture where your contributions are valued and recognized.
Career Growth Opportunities

At Child and Adult Empower Mental Clinic Services, we are committed to nurturing the professional growth of our team members. You will have access to regular supervision and mentoring, enabling you to develop specialized skills and advance in your career. The organization supports the pursuit of additional certifications and training areas within mental health, reinforcing our dedication to excellence in care.

Why Join Our Team

If you are an experienced LCSW passionate about making a tangible difference in the lives of individuals facing addiction and mental health challenges, we invite you to apply. Join a team that values empathy, collaboration, and the empowerment of both clients and staff. With a commitment to providing high-quality care, working with us at Child and Adult Empower Mental Clinic Services means being part of a mission that promotes recovery and improves lives.

Application Information

Ready to make an impact? Please submit your resume and a cover letter detailing your relevant experience and passion for mental health services. We look forward to hearing from you and exploring the opportunity to work together in this rewarding field.