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Remote Utilization Review Manager Jobs in Merced, CA

American AgCredit

Capital Markets Loan Processor

Merced, CA · On-site +1

$19.75 - $26.50/hr

Manage distribution of information to staff and other lenders or partners as appropriate. * Review ... PART-TIME REMOTE/HYBRID: These employees will work partly remote and partly onsite. Part-time ...

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 Jul 25, 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 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 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, and why are they important?

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 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

Senior Director, Pharmacy

Centene Pharmacy Services

Dos Palos, CA • On-site, Remote

$185K - $352K/yr

Full-time

Medical, Retirement, PTO

Posted 2 days ago

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.

Position Purpose: Manage all aspects of pharmacy operations in two markets with multiple products. Perform duties to develop, direct and implement a pharmacy benefit management program. Aid in formulating and administering related organizational policies and procedures, including pharmacy service quality, pharmacy utilization management and achievement of Company goals for pharmacy and medical programs.
  • Establish the strategic vision, objectives and policies and procedures for the pharmacy program in support of the Corporate strategic vision for multiple plans and markets.
  • Plan, direct and implement pharmacy activities for multiple plans and products.
  • Act as the pharmacy contract administrator for the development and implementation of key contracts and ensure that relevant performance standards are met by vendors.
  • Participate in external accreditation initiatives for multiple plans and products.
  • Manage and analyze operating costs and participate in preparing materials needed for budget planning or special initiatives.
  • Generate, review and analyze drug utilization, utilization management, financial and other ad-hoc reports, records and directives. Confer with staff to obtain data required for planning work function activities.
  • Review statistical analysis in support of recommendations and/or decision making for policies and operational procedures.
  • Maintain daily communication with plan management relative to each market and product.
  • Manage pharmacy department staff to assure adequate coverage and support in multiple locations and for multiple products.
  • Support provider education initiatives such as counter detailing and incentive programs in multiple markets.
Education/Experience: Bachelor’s degree in Pharmacy or advanced pharmacy degree (PharmD., M.S.) from an accredited college of pharmacy. 6+ years of clinical pharmacy care experience. 1+ years of experience managing a pharmacy program. Managed care, retail or hospital pharmacy experience required. Thorough knowledge of pharmaceutical care and pharmacy benefit management practices. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
Licenses/Certifications: Current Pharmacist license. Ability to receive license in additional states as required. Valid driver's license.Pay Range: $185,700.00 - $352,500.00 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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