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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 ...

InsCipher

Tax Associate

Merced, CA · Remote

$21 - $26/hr

Conduct compliance and quality review on documents, state legislation, codes and procedures ... Manage multiple priorities in a high-volume position, deliver timely and accurate work products ...

World Wide Technology

Project Coordinator

Merced, CA · Remote

$24.81 - $31.01/hr

Remote - Nationwide, United States Project Coordinator, IT Infrastructure Why WWT? At World Wide ... Why should you join the PMO? As a Project Coordinator, you will be working on exciting ...

Workiva

Spring 2027 Intern - Marketing (MBA)

Merced, CA · On-site +1

$35/hr

... management * Perform go-to-market performance reviews, including win/loss analysis, to identify ... This internship is primarily a remote opportunity. However, if you are located near one of our ...

New

ABB

Commercial Strategy Intern - Spring 2027

Merced, CA · Remote

$20 - $34/hr

The work model for the role is Remote based out of Florida, USA. This role is contributing to the ... Seeking feedback and guidance from manager and team members to improve performance and skills.

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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

Medicare Membership & Eligibility Analyst (Temporary)

Central California Alliance for Health (Remote)

Merced, CA • On-site, Remote

$36 - $48/hr

Full-time, Temporary

Medical, Dental, Vision, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Job description

OUR COMMITMENT TO A HUMAN HIRING PROCESS

We believe every candidate deserves thoughtful consideration. That's why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer — and we genuinely appreciate your patience as we work through applications carefully and respectfully. 

SERVICE AREA PREFERENCE

While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. 

ABOUT THIS TEMP POSITION

This is a temporary position and the length of assignment is estimated to go until December 31, 2026. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Medicare Operations Director, this position:

  • Supports Medicare operations, sales, and enrollment functions through analysis and interpretation 
    of Medicare and Medi-Cal data and ensures compliance with applicable state and federal 
    regulations
  • Conducts complex research and analysis in support of Medicare Operations activities
  • Acts as a subject matter expert and liaison to internal and external stakeholders 
WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description and list of requirements, click here. 

  • Knowledge of:
    • CMS guidelines related to Medicare sales and enrollment
    • Medicare Advantage enrollment processes and financial reconciliation
    • Contents and interpretation of monthly membership reports
    • Research, analysis, and reporting methods
    • Data analysis tools, CRM/enrollment systems, and the use of databases
  • Ability to:
    • Analyze complex data sets and present actionable insights
    • Identify issues, gather and analyze information and data, reach logical and sound  conclusions, and make recommendations for action
    • Interpret, explain and apply applicable policies, laws, codes, regulations, and contracts
    • Organize work, manage multiple projects, establish priorities, adjust to changing priorities, and meet deadlines
    • Assist with the development and implementation of projects, systems, programs, policies, and procedures
    • Develop and implement operational workflows
  • Education and Experience:
    • Bachelor's degree in Business Administration, Health Care Administration, Public Health, or a related field
    • Minimum of five years of progressively responsible experience related to Medicare membership operations and/or enrollment eligibility 
    • Master's degree may substitute for two years of the required experience; or an equivalent combination of education and experience may be qualifying
OTHER INFORMATION
  • We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams.
  • While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
  • In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.
  • This is a temporary position and does not provide the benefits that are listed below (this is standard language from our regular job posts and cannot be altered or removed). Temporary employees on assignment at the Alliance will be connected to a staffing agency with separate benefit options. 

COMPENSATION INFORMATION

  • Zone 1 Pay Range: $36.00 - $48.00
    Typical areas in Zone 1: Santa Cruz, San Benito, and Monterey Counties, Bay Area, Sacramento, Los Angeles and San Diego areas
  • Zone 2 Pay Range: $34.00 - $45.00
    Typical areas in Zone 2: Mariposa and Merced Counties, Fresno area, Bakersfield, Eastern California, San Luis Obispo area, and the Central Valley (except Sacramento)

The applicable salary ranges are based on work location and are aligned to a zone according to the cost of labor in your area. All ranges are subject to change in the future. We are happy to answer any questions that you have or share the applicable pay zone for your location if it's not one of the typical areas listed. You can reach out to careers@thealliance.health, and a member from our Talent Acquisition team will be in touch.

The posted hiring ranges represent a good‑faith estimate of what a temporary employee would be paid on this assignment. Final compensation will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education, or training), as well as other factors (internal equity, market factors, and geographic location).

OUR BENEFITS
  • Medical, Dental and Vision Plans
  • Ample Paid Time Off
  • 12 Paid Holidays per year
  • 401(a) Retirement Plan
  • 457 Deferred Compensation Plan
  • Robust Health and Wellness Program
  • Onsite EV Charging Stations
  • And many more
ABOUT US

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. 

The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer

Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet.

At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.