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Remote Utilization Review Manager Jobs in Merced, CA

Centene

Psychologist Reviewer

Dos Palos, CA · Remote

$87K - $157K/yr

... utilization management processes * Interact with the Medical Director, or designee, to discuss ... review by a PhD/PsyD * Facilitate outpatient rounds offering clinical input and oversight related ...

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All JobsUtilization Review JobsRemote Utilization Review Manager JobsRemote Utilization Review Manager Jobs in Merced, CA

Remote Utilization Review Manager information

See Merced, CA salary details

$41.2K

$96.1K

$176.9K

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

As of Sep 5, 2026, the average yearly pay for remote utilization review manager in Merced, CA is $96,110.00, according to ZipRecruiter salary data. Most workers in this role earn between $62,800.00 and $115,600.00 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 Merced, CA?

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

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

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

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

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

Remote Utilization Review Manager jobs near you

Psychologist Reviewer

Centene

Dos Palos, CA • Remote

$87K - $157K/yr

Full-time

Medical, Retirement, PTO

Posted 16 days ago

Centene rating

8.4

Company rating: 8.4 out of 10

Based on 406 frontline employees who took The Breakroom Quiz

12th of 898 rated healthcare providers

Job description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Job Description

Centene is Hiring – Remote Psychologist Reviewers (ABA)

Centene is seeking Remote Psychologist Reviewers (Applied Behavior Analysis).

Candidates must hold an active, unrestricted California Psychologist license. This is a remote position, and applicants may reside anywhere within the United States; however, a current California license is required.

Join Centene’s mission-driven team as a Remote Psychologist Reviewer specializing in Applied Behavior Analysis (ABA) with a focus on individuals with Autism.

We’re seeking a dedicated professional who is passionate about improving the lives of youth with Autism. The ideal candidate will also hold a BCBA certification to support our growing markets and ensure high-quality, evidence-based behavioral health care.

Why Join Us?

  • 100% remote flexibility

  • Meaningful work impacting care for youths with Autism

  • Be part of a collaborative, supportive team committed to clinical excellence

Position Purpose:
Authorize, direct and monitor care for behavioral health and/or substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care

  • Conduct peer reviews with psychologists, behavioral health therapists and/or Board Certified Behavior Analysts for outpatient services and/or psychological testing requests

  • Interact with network practitioners to provide education on best practice models and utilization management processes

  • Interact with the Medical Director, or designee, to discuss clinical authorization questions and concerns regarding specific cases

  • Respond to state, provider, and member complaints related to psychological testing or other services requiring review by a PhD/PsyD

  • Facilitate outpatient rounds offering clinical input and oversight related to outpatient services

  • Performs other duties as assigned.

  • Complies with all policies and standards.

Education/Experience: PhD Clinical Psychology, Counseling, Behavior Analysis, or related field required
: 2+ years Behavioral Health required
Working knowledge of psychological tests and testing procedures, diagnostic evaluations and evidence-based practices. required
For ABA Reviewers only, working knowledge of psychological tests and testing procedures, diagnostic evaluations and evidence-based practices designed for individuals with Autism Spectrum Disorder. required
Licenses/Certifications:
PSY - Psychologist Unrestricted License (PhD or PsyD) Upon Hire required
Board Certified Behavior Analyst (BCBA) BCBA-D Upon Hire preferred:

Pay Range: $87,700.00 - $157,800.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.


Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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