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Remote Utilization Review Nurse Jobs in San Ramon, CA

Registered Nurse

San Jose, CA ยท Remote

$140 - $150/hr

Review OASIS assessments for completeness, appropriateness, and compliance with federal and state ... Monitor visit utilization and flag potential financial risks or underutilization to clinical ...

Showing results 21-40

Remote Utilization Review Nurse information

See San Ramon, CA salary details

$23

$47

$77

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

As of Aug 21, 2026, the average hourly pay for remote utilization review nurse in San Ramon, CA is $47.25, according to ZipRecruiter salary data. Most workers in this role earn between $37.36 and $54.28 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.

What job categories do people searching Remote Utilization Review Nurse jobs in San Ramon, CA look for?

The top searched job categories for Remote Utilization Review Nurse jobs in San Ramon, CA are:

What cities near San Ramon, CA are hiring for Remote Utilization Review Nurse jobs?

Cities near San Ramon, CA with the most Remote Utilization Review Nurse job openings:

Infographic showing various Remote Utilization Review Nurse job openings in San Ramon, CA as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 12% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $98,282 per year, or $47.3 per hour.

Remote Licensed Clinical Social Worker for Detox Center in San Jose

Horizon Mental Care Services

San Jose, CA โ€ข Remote

Full-time

Medical, Retirement, PTO

Posted 2 days ago

New


Job description

Position Overview

Horizon Mental Care Services is seeking a dedicated and compassionate Licensed Clinical Social Worker (LCSW) to join our team in a full-time remote role. This position is centered around providing therapeutic support to individuals in a detox treatment center, ensuring both their mental and emotional well-being as they navigate through their recovery journey. The LCSW will play a pivotal role in conducting assessments, leading therapy sessions, and engaging in case management duties to promote client safety and recovery.

About the Organization

Horizon Mental Care Services is a leading provider of mental health and substance abuse care in California, committed to enhancing the quality of life for individuals facing challenges related to addiction and mental health. Our detox center in San Jose is designed to provide a safe and supportive healing environment. We prioritize personalized care through evidence-based practices and a compassionate approach, empowering our clients to achieve lasting recovery. Becoming part of our team means joining a passionate community of mental health professionals dedicated to making a meaningful difference in the lives of those we serve.

Work Environment

This position offers a unique opportunity to work remotely, providing flexibility while being part of a dynamic, interdisciplinary team focused on delivering exceptional care to our clients. Despite the remote setup, collaboration is fostered through regular meetings, virtual team-building events, and accessible communication channels, ensuring that all team members remain integrated and supported. The detox center is equipped with innovative tools and resources to facilitate patient engagement and enhance the overall treatment experience.

Key Responsibilities
  • Conduct thorough clinical evaluations upon patient admission, assessing their needs and developing individualized treatment plans.
  • Lead psychoeducational and process-oriented therapy groups, creating a safe space for clients to share experiences and learn coping strategies.
  • Oversee case management duties, including coordinating discharge planning from the moment of admission to ensure a smooth transition for patients back to their everyday lives.
  • Engage in effective communication with both clients and their families, confirming discharge appointments and ensuring that transition plans are fully understood and actionable.
  • Collaborate with the Utilization Review Department to discuss patient progress, treatment authorizations, and financial aspects to facilitate the continuum of care.
  • Provide additional clinical support to fellow team members in their absence, demonstrating a strong sense of teamwork and commitment to the clientโ€™s welfare.
  • Document all clinical activities and client interactions efficiently, adhering to regulatory and organizational standards.
Patient Population / Client Focus

The primary patient population includes individuals experiencing substance abuse issues seeking detoxification. The LCSW will work closely with clients who may also present co-occurring mental health disorders, necessitating tailored interventions that address both addiction and underlying psychological issues. Through compassionate engagement, the LCSW will empower clients in actively participating in their recovery, improving their resilience and coping mechanisms.

Qualifications
  • A Masterโ€™s degree in Social Work from an accredited institution.
  • Active licensure as a Clinical Social Worker (LCSW) in the state of California.
  • Strong skills in written and verbal communication, able to convey complex information clearly to clients and collaborators alike.
  • Proven ability to establish and maintain appropriate boundaries with clients, fostering a safe therapeutic environment.
  • High level of organizational skills to manage documentation and deadlines efficiently.
Preferred Experience
  • Previous experience working in a detox or addiction treatment setting is highly desirable.
  • Understanding of motivational interviewing techniques and their application in behavioral health settings.
  • Familiarity with electronic health records (EHR) systems to streamline documentation and client management.
Compensation and Benefits

The salary range for this position is between USD 120,000 and 130,000 per year, determined by experience and caseload. In addition to a competitive salary, Horizon Mental Care Services offers a comprehensive benefits package that includes health insurance, retirement savings plans, and paid time off. We believe in investing in our staff, providing opportunities for professional development, continuing education, and skill enhancement to promote career advancement.

Career Growth Opportunities

At Horizon Mental Care Services, we are committed to fostering an environment of growth and learning. Our staff have access to ongoing professional development programs, mentorship opportunities, and the potential for career advancement within the organization. Whether you aspire to specialize further in clinical practice or take on leadership roles, we provide the resources to help you achieve your professional goals.

Why Join Our Team

Joining our team means being part of an organization that values compassion, collaboration, and innovation. We emphasize a supportive work culture that recognizes the contributions of each team member and prioritizes client-centered care. Your work as an LCSW will directly impact the lives of individuals seeking recovery, giving you a profound sense of fulfillment and purpose. Together, we can help build healthier communities and empower individuals to reclaim their lives.

Application Information

If you are excited about this opportunity and meet the qualifications outlined above, we encourage you to apply. Submit your resume and a cover letter detailing your experience and motivations for joining Horizon Mental Care Services. We look forward to hearing from you and potentially welcoming you to our dedicated team of professionals!