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Remote Utilization Review Rn Jobs in Carlsbad, CA

Welby Health

Lead Care Manager (Remote)

Carlsbad, CA · Remote

$92K - $110K/yr

Conduct proactive outreach, device data review, care plan updates, and care coordination consistent ... Active and valid registered nurse (RN) license in good standing * Minimum of three (3) to five (5) ...

New

AccentCare, Inc.

Scheduler

San Marcos, CA · On-site +1

$18 - $24.25/hr

Scheduler Position Type: Full-Time Remote/Virtual Position: No Find Your Passion and Purpose as an ... Experience with scheduling RN, LPN, CNA, HHA with home-based clients. Experience with Caregiver EVV ...

New

Integrated Resources INC

Case Manager - Remote

San Diego, CA · Remote

$21.25 - $27.25/hr

Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing. This is a TEMP ... The manager is flexible with a 30 or 60 minute typical day will consist of scheduling reviews that ...

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

Remote Utilization Review Rn information

See Carlsbad, CA salary details

$22

$43

$71

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

As of Sep 3, 2026, the average hourly pay for remote utilization review rn in Carlsbad, CA is $43.86, according to ZipRecruiter salary data. Most workers in this role earn between $34.66 and $50.38 per hour, depending on experience, location, and employer.

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 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 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 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 popular job titles related to Remote Utilization Review Rn jobs in Carlsbad, CA?

For Remote Utilization Review Rn jobs in Carlsbad, CA, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Rn jobs in Carlsbad, CA look for?

The top searched job categories for Remote Utilization Review Rn jobs in Carlsbad, CA are:

What cities near Carlsbad, CA are hiring for Remote Utilization Review Rn jobs?

Cities near Carlsbad, 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 Carlsbad, 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 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $91,232 per year, or $43.9 per hour.

Internal Medicine job in San Diego CA

Inspire Healthcare

San Diego, CA • On-site, Remote

$250K - $350K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 15 days ago

Job description

We are seeking a Remote Medical Director for a non-clinical role focused on prior authorization and medical necessity reviews. No direct patient care is required. Candidates must reside in the San Diego area and be available for occasional on-site meetings and trainings.

Responsibilities
  • Review prior authorization requests and determine medical necessity using evidence-based clinical guidelines.
  • Approve, deny, modify, or redirect services as appropriate.
  • Collaborate with nurses, physicians, and care management teams to support high-quality, cost-effective care.
  • Participate in appeals, grievance reviews, retrospective claims reviews, and quality improvement initiatives.
  • Serve as a clinical resource to providers on utilization management and patient care issues.
Qualifications
  • MD or DO degree required.
  • Board Certification in Internal Medicine strongly preferred.
  • Minimum 5 years of clinical experience required.
  • 2+ years of managed care, health plan, or utilization management experience preferred.
  • Strong knowledge of prior authorization processes and medical necessity criteria.
  • Excellent communication, organizational, and decision-making skills.
  • Proficiency with Microsoft Office and remote work technology.
Compensation & Benefits
  • Salary: $250,000"$350,000 annually DOE.
  • Comprehensive benefits package including medical, dental, vision, 401(k), paid time off, life insurance, FSA, tuition reimbursement, CME/license reimbursement, and employee assistance programs.

This is an excellent opportunity to join one of Southern California's fastest-growing physician organizations in a leadership role that supports quality patient care while maintaining work-life balance.

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About Inspire Healthcare

Sourced by ZipRecruiter

Inspire Healthcare, based in Boynton Beach, FL, US, is a dynamic firm in the healthcare staffing industry. Established with the dedication to provide a quality recruitment service to the healthcare sector, it is dedicated to assisting healthcare providers with their staffing needs. Its official website, ihcrecruiting.com, presents a comprehensive portfolio of services that cater to diverse healthcare facilities and positions. Its mission is firmly rooted in delivering professional healthcare staffing services that fulfill clients' needs efficiently and effectively, while also creating prosperous opportunities for healthcare professionals. A notable achievement of the company is its breadth of service, extending its recruiting coverage all across the country.

Industry

Recruiting and staffing services

Company size

11 - 50 Employees

Headquarters location

Boynton Beach, FL, US

Social media

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