ZipRecruiter

Log In

2

Remote Utilization Review Rn Jobs in Anaheim, CA

Imh

RN Care Manager

West Covina, CA · Remote

$41.20 - $62.17/hr

Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...

Zócalo Health

RN Case Manager

Los Angeles, CA · Remote

$85K/yr

RN Case Manager Remote (Full Time) *Must reside in California* Compensation: $85,000 About Us ... Support quality, utilization, and member outcome goals established by the organization and health ...

Molina Healthcare

Care Review Clinician (RN)

Long Beach, CA · On-site +1

$26.41 - $51.49/hr

... to utilization management (UM) policies and procedures. Required Qualifications • At least 2 ... • Registered Nurse (RN). License must be active and unrestricted in state of practice. • ...

Astrana Health, Inc.

Care Manager I - RN

Monterey Park, CA · On-site +1

$78K - $91K/yr

At least two (2) years' experience in utilization management including experience applying ... This is a remote position. The home office is located at 1600 Corporate Center Dr., Monterey Park ...

New

Astrana Health

Care Manager I - RN

Monterey Park, CA · Remote

$78K - $91K/yr

At least two (2) years' experience in utilization management including experience applying ... This is a remote position. The home office is located at 1600 Corporate Center Dr., Monterey Park ...

New

previous pagenext page

Showing results 21-40

All JobsUtilization Review Rn JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in Anaheim, CA

Remote Utilization Review Rn information

See Anaheim, CA salary details

$22

$44

$72

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

As of Aug 8, 2026, the average hourly pay for remote utilization review rn in Anaheim, CA is $44.27, according to ZipRecruiter salary data. Most workers in this role earn between $35.00 and $50.82 per hour, depending on experience, location, and employer.

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

To excel as a Remote Utilization Review RN, you need a valid RN license, strong clinical judgment, and knowledge of utilization management principles. Familiarity with electronic medical records (EMR), utilization management software, and guidelines such as InterQual or MCG is typically required. Outstanding attention to detail, critical thinking, and effective communication skills help you collaborate with healthcare teams and advocate for appropriate patient care. These competencies are crucial for ensuring medical necessity, regulatory compliance, and optimal resource use in a remote setting.

What is a remote utilization review RN?

A Remote Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients, typically working from a remote location. They review medical records, apply clinical guidelines, and collaborate with healthcare providers to ensure patients receive the right care at the right time. Their work helps manage healthcare costs and improves patient outcomes by preventing unnecessary treatments or hospital stays. Remote Utilization Review RNs often work for insurance companies, hospitals, or healthcare organizations, and use secure digital platforms to conduct their reviews.

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

AspectRemote Utilization Review RnRemote Case Manager Rn
CertificationsRN license, Utilization Review certification (e.g., URAC)RN license, Case Management certification (e.g., CCM)
Work EnvironmentReviewing medical records, insurance policies, telehealth platformsCoordinating patient care, discharge planning, telehealth
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance providers, healthcare agencies

Remote Utilization Review Rns primarily focus on evaluating medical necessity for insurance coverage, while Remote Case Manager Rns coordinate patient care and discharge planning. Both roles require RN licensure and involve telehealth work, but they serve different functions within healthcare and insurance industries.

What are some common challenges remote utilization review RNs face when working from home, and how can they be addressed?

Remote Utilization Review RNs often encounter challenges such as maintaining clear communication with interdisciplinary teams, managing time efficiently, and staying updated on changing payer guidelines. To address these challenges, it's important to establish consistent check-ins with team members via video or chat platforms, use digital tools to organize and prioritize caseloads, and participate in ongoing training sessions provided by employers. Adhering to a structured daily routine and leveraging available technology can help ensure productivity and high-quality reviews while working remotely.
What are popular job titles related to Remote Utilization Review Rn jobs in Anaheim, CA? For Remote Utilization Review Rn jobs in Anaheim, CA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Anaheim, CA look for? The top searched job categories for Remote Utilization Review Rn jobs in Anaheim, CA are:
What cities near Anaheim, CA are hiring for Remote Utilization Review Rn jobs? Cities near Anaheim, CA with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you
Infographic showing various Remote Utilization Review Rn job openings in Anaheim, CA as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 16% Part Time, and 2% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $92,072 per year, or $44.3 per hour.

Care Review Clinician (RN) Remote (AZ)

Molina Healthcare

Long Beach, CA • On-site, Remote

$26.41 - $51.49/hr

Full-time

This job post has expired 1 day ago. Applications are no longer accepted.

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 198 frontline employees who took The Breakroom Quiz

163rd of 303 rated insurance

Job description


JOB DESCRIPTION
This position will support the Arizona state Plan. We are seeking a candidate with an Arizona RN licensure. The ideal candidate will have experience with UM and prior authorization with both inpatient and outpatient. Candidates with a Behavioral Health background are highly preferred. Further details to be discussed during our interview process. Prefers candidates with 3 years of experience.
Remote position, must reside in Arizona.
Work hours: Monday - Friday 8:30am- 5:00pm Mountain Time with some weekends and holidays.
Job Summary
Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.
• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
• Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.
• Processes requests within required timelines.
• Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
• Requests additional information from members or providers as needed.
• Makes appropriate referrals to other clinical programs.
• Collaborates with multidisciplinary teams to promote the Molina care model.
• Adheres to utilization management (UM) policies and procedures.
Required Qualifications
• At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Ability to prioritize and manage multiple deadlines.
• Excellent organizational, problem-solving and critical-thinking skills.
• Strong written and verbal communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
• Certified Professional in Healthcare Management (CPHM).
• Recent hospital experience in an intensive care unit (ICU) or emergency room.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

What Molina Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Molina Healthcare logo

About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

Social media

FacebookTwitter

View All Molina Healthcare Jobs

Apply