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Remote Utilization Review Nurse Jobs in Rialto, CA

IQVIA

Flex Nurse Educator

Menifee, CA · Remote

Deliver remote patient education, including medication administration training and adherence ... Candidates must possess a valid driver's license and will be subject to a review of their driving ...

Ensign Services, Inc.

Managed Care Resource

Pomona, CA · On-site +1

$110K - $130K/yr

The Managed Care Consultant supports the Skilled Nursing Facility leaders in managed care ... Assess resource utilization, cost management and negotiate effectively. * Monitor industry changes ...

IQVIA

Clinical Trial Psych Rater

Moreno Valley, CA · Remote

Remote/Virtual Hours: Estimated 10-16 hours per month Role: Clinical Specialist About IQVIA IQVIA ... This position involves reviewing scales administered by raters to confirm standardized assessment ...

IQVIA

Clinical Trial Psych Rater

Colton, CA · Remote

Remote/Virtual Hours: Estimated 10-16 hours per month Role: Clinical Specialist About IQVIA IQVIA ... This position involves reviewing scales administered by raters to confirm standardized assessment ...

IQVIA

Clinical Trial Psych Rater

Riverside, CA · Remote

Remote/Virtual Hours: Estimated 10-16 hours per month Role: Clinical Specialist About IQVIA IQVIA ... This position involves reviewing scales administered by raters to confirm standardized assessment ...

ABB

Utility Sales Support

La Verne, CA · Remote

$17.75 - $23.25/hr

While this is a remote position, candidates must be located in the United States. You will be ... Must have knowledge and skill in utilization of computer databases; empower experience preferred

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All JobsUtilization Review Nurse JobsRemote Utilization Review Nurse JobsRemote Utilization Review Nurse Jobs in Rialto, CA

Remote Utilization Review Nurse information

See Rialto, CA salary details

$21

$42

$69

How much do remote utilization review nurse jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for remote utilization review nurse in Rialto, CA is $42.40, according to ZipRecruiter salary data. Most workers in this role earn between $33.51 and $48.70 per hour, depending on experience, location, and employer.

What is a remote utilization review nurse?

A Remote Utilization Review Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments, typically from a remote location such as their home. They review patient medical records, apply clinical guidelines, and collaborate with providers and insurance companies to ensure patients receive appropriate care while managing healthcare costs. This role often involves making coverage determinations, conducting pre-authorizations, and participating in appeals processes. Remote Utilization Review Nurses play a critical role in improving patient outcomes and resource allocation within the healthcare system.

What does a remote utilization review nurse do?

As a remote utilization nurse, your duties are to work from home or a remote location to review patient medical records and prepare a range of paperwork for different types of actions a hospital or health care provider can take. Your responsibilities are to determine patient coverage, carry out denial of service authorizations, and negotiate different treatment options and hospital stay length for patients. You rely on your knowledge of treatment options and diseases to determine the level of appropriate care for a patient. Because you telecommute, you also need good technical skills.

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

To thrive as a Remote Utilization Review Nurse, you need a current RN license, clinical experience, and a solid understanding of medical necessity criteria and healthcare regulations. Familiarity with utilization management software, EHR systems, and certifications like CCM or URAC are highly valued. Strong analytical thinking, attention to detail, and effective communication skills enable success in evaluating clinical documentation and collaborating with providers remotely. These skills and qualifications are essential to ensure efficient, compliant care decisions that optimize patient outcomes and resource use.

How does a remote utilization review nurse collaborate with physicians and other healthcare team members while working remotely?

As a Remote Utilization Review Nurse, collaboration with physicians, case managers, and other healthcare professionals is primarily conducted through secure digital platforms such as email, video conferencing, and electronic health record systems. Effective communication is essential to discuss patient care plans, clarify medical necessity, and ensure compliance with utilization policies. Nurses in this role often participate in virtual meetings or case conferences to present findings and recommendations. Building strong working relationships remotely requires proactive communication, responsiveness, and familiarity with digital collaboration tools.

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

AspectRemote Utilization Review NurseRemote Case Manager
CertificationsRN license, possibly CCM or UR certificationsRN license, CCM or case management certifications
Work EnvironmentHealthcare facilities, insurance companies, telehealthInsurance companies, healthcare organizations, telehealth
Job FocusReview medical necessity, approve or deny servicesCoordinate patient care, arrange services, discharge planning

Remote Utilization Review Nurses primarily evaluate medical necessity for services, while Remote Case Managers coordinate patient care and discharge planning. Both roles require nursing credentials and work in healthcare or insurance settings, but their core responsibilities differ. Understanding these distinctions helps job seekers find the best fit for their skills and career goals.

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Remote Utilization Review Nurse jobs near you
Infographic showing various Remote Utilization Review Nurse job openings in Rialto, CA as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 11% Part Time, 2% Contract, and 1% Nights. Highlights an 78% Physical, 2% Hybrid, and 20% Remote job distribution, with an average salary of $88,190 per year, or $42.4 per hour.

Flex Nurse Educator

IQVIA

Menifee, CA • Remote

Full-time

Posted 19 days ago

IQVIA rating

8.1

Company rating: 8.1 out of 10

Based on 53 frontline employees who took The Breakroom Quiz

62nd of 226 rated it services

Job description

Flex Nurse Educator

IQVIA - Advancing Patient Support and Education. IQVIA, the world's premier provider of commercial healthcare solutions, is seeking licensed healthcare professionals for the position of Flex Nurse Educator. This role supports patient care through both remote and, when required, in-field coverage, ensuring continuity during staff absences and territory vacancies.

Job Responsibilities:
  • Deliver remote patient education, including medication administration training and adherence support, via telephonic, video, email, SMS, and secure messaging platforms.
  • This is an educational, non-clinical position. Nurse Educators do not provide medical advice but empower patients to manage their disease and improve treatment compliance. Join IQVIA's team of over 10,000 representatives and help deliver medical breakthroughs to those who need them most.
  • Provide in-person support and education exclusively during coverage of territory vacancies, such as home visits and other approved designated locations, maintaining privacy and high educational standards.
  • Facilitate connections to program-approved resources and encourage dialogue between patients and healthcare providers.
  • Maintain accurate documentation, follow approved protocols, and uphold KPIs and compliance standards.
  • Collaborate with District Managers and Field Leadership, participate in training sessions and strategic planning, and assist in onboarding and mentoring new team members as needed.
  • Coordinate and facilitate the connection between patients and program-approved, patient-based resources.
  • Provide educational training to patients on specific disease states and prescribed medication.
  • Provide patient-focused education to empower patients to adhere to specific treatment compliance as directed by their HCP.
  • Foster appropriate dialogue between patient and health care provider
  • Support patients throughout their treatment journey, addressing access barriers and promoting behavioral change for optimal health outcomes.
  • Participate in ongoing professional development, team meetings, and quality improvement initiatives.
  • Adhere strictly to program guidelines, ensuring non-clinical and educational interactions with patients.
  • Uphold territory-specific targets and compliance with company and regulatory standards.
Schedule
  • Ability to travel up to 50% for in-field assignments and coverage as needed.
  • Monday - Friday and flexibility to work weekends and evenings
Required Qualifications:
  • Active RN license in good standing (compact multi-state preferred); may be required to obtain additional licensure in multiple states.
  • Bachelor's degree
  • Must possess or be willing to obtain a California RN Licensure if residing in the Mountain or Pacific time zone
  • Must reside within the specific geography
  • At least 5 years clinical experience in hospital, home health, pharmaceutical, or biotech settings.
  • Exceptional communication, organization, and time management skills, including experience managing multiple territories and prioritizing projects and deadlines.
  • Proficient in virtual platforms, documentation, MS Office, and iPad technology
  • Private designated workspace at home required
  • Driving is required for this role. Candidates must possess a valid driver's license and will be subject to a review of their driving record prior to hire.
  • Must reside in country where the job is posted.
Preferred Qualifications:
  • Nurse educator background a plus
  • Bilingual in English/Spanish and prior Ambassador experience desirable.
  • BSN preferred

Compensation

  • Competitive annual salary

  • Bonus eligibility

This is an educational, non-clinical position. Nurse Educators do not provide medical advice but empower patients to manage their disease and improve treatment compliance.

Note: This role is not eligible for visa sponsorship. Candidates must have authorization to work in the US without the need for sponsorship.

#LI-CES

#LI-REMOTE

IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more athttps://jobs.iqvia.com

IQVIA is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable law. https://jobs.iqvia.com/eoe

IQVIA is committed to integrity in our hiring process and maintains a zero tolerance policy for candidate fraud. All information and credentials submitted in your application must be truthful and complete. Any false statements, misrepresentations, or material omissions during the recruitment process will result in immediate disqualification of your application, or termination of employment if discovered later, in accordance with applicable law. We appreciate your honesty and professionalism.

The potential base pay range for this role is $90,000-$95,000 annually. The actual base pay offered may vary based on a number of factors including job-related qualifications such as knowledge, skills, education, and experience; location; and/or schedule (full or part-time). Dependent on the position offered, incentive plans, bonuses, and/or other forms of compensation may be offered, in addition to a range of health and welfare and/or other benefits.

What IQVIA employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

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About IQVIA

Sourced by ZipRecruiter

At IQVIA, we are passionate about helping customers and partners improve results and patient outcomes. Everything we do contributes to this vision for creating a healthier world. In today’s healthcare environment, it’s not only about how much data, information, and technology you have at your fingertips – it’s what you do with it. IQVIA is focused on making intelligent connections for customers across the entire healthcare ecosystem to help you drive healthcare forward. Whether that means partnering with novel technology companies to boost patient engagement, leveraging AI & machine learning to accelerate results, or using decentralized trials to reach the right patients wherever they are – we are always looking for smarter ways to move you forward.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Durham, NC, US

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