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Remote Utilization Review Rn Jobs in Carson, CA (NOW HIRING)

Dragonfly Recruiting

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Utilization Management Inpatient Coordinator

Orange, CA · Remote

$23 - $26/hr

Utilization Management Coordinator - Inpatient Review (Health Plan) Remote | Contract-to-Permanent ... This role supports inpatient, and skilled nursing facility (SNF) utilization review workflows ...

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Remote Utilization Review Rn information

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$22

$44

$72

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

As of Jun 13, 2026, the average hourly pay for remote utilization review rn in Carson, CA is $44.22, according to ZipRecruiter salary data. Most workers in this role earn between $34.95 and $50.77 per hour, depending on experience, location, and employer.

What is the meaning of the word remote?

In the context of a Remote Utilization Review RN job, 'remote' refers to working outside of a traditional office setting, often from home or another location of the employee's choice. This setup typically involves using digital tools and communication platforms to perform job duties without being physically present in an office environment.

What are the key skills and qualifications needed to thrive as a Remote Utilization Review RN, and why are they important?

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 meaning of remote in one word?

In the context of a Remote Utilization Review RN role, 'remote' means working from a location outside of a traditional office, typically from home, using digital communication tools. It emphasizes flexibility and virtual access to work systems without physical presence at a healthcare facility.

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.

How to make 2000 a week working from home?

A Remote Utilization Review RN can potentially earn $2,000 weekly by working full-time hours, often 40 hours per week, and gaining experience or certifications that allow for higher billing rates. Increasing income may involve taking on additional cases, specializing in high-demand areas, or working for agencies that offer competitive pay for remote utilization review roles.

What is remote job?

A remote Utilization Review RN job is a healthcare position where the nurse reviews patient cases and insurance claims from a location outside of a traditional office, often working from home. It requires strong communication skills, knowledge of medical documentation, and familiarity with electronic health record systems, with flexible schedules common in remote roles.

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 Carson, CA? For Remote Utilization Review Rn jobs in Carson, CA, the most frequently searched job titles are:
What cities near Carson, CA are hiring for Remote Utilization Review Rn jobs? Cities near Carson, CA with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you
Utilization Review RN or LVN (Inpatient/Concurrent Review) CA License

Utilization Review RN or LVN (Inpatient/Concurrent Review) CA License

Dragonfly Recruiting

Orange, CA • Remote

$48 - $50.48/hr

Full-time

Medical, Dental, PTO

Posted 7 days ago

Job description

Job Type: Full-time, Contract to Permanent Hire.
Schedule: Monday - Friday, Tuesday - Saturday, or Sunday - Thursday.

8:00 AM – 5:00 PM PST (Must be able to work Pacific hours)
Location: Remote (California license required - CA is NOT a compact state))

Job Summary
We’re seeking an experienced Utilization Management Nurse (RN or LVN) to support inpatient review and care coordination for patients requiring ongoing medical oversight. This role is designed for nurses who want to make an impact by ensuring patients receive safe, appropriate, and cost-effective care. You’ll partner with physicians, hospital staff, and case managers to coordinate treatment plans and transitions of care.

This position is remote, though an active California nursing license is required. California is NOT a compact state.

Responsibilities

  • Perform inpatient concurrent reviews and assess admissions/continued stays using MCG (Milliman Care Guidelines).
  • Provide oversight for patients with complex or chronic conditions, identifying those who may require post-discharge case management.
  • Communicate with physicians, case managers, and discharge planners to coordinate patient care plans.
  • Participate in interdisciplinary team meetings and patient rounds.
  • Accurately document clinical activities and case updates in the care management system.
  • Track case progress and provide updates to UM leadership.
  • Monitor for overutilization or underutilization patterns and escalate concerns when needed.

Qualifications

Required:

  • Current, unrestricted California RN or LVN license.
  • At least 2 years of inpatient review, or utilization management experience.
  • Familiarity with evidence-based criteria such as Milliman Care Guidelines (MCG) and CMS Guidelines.

Preferred (not required):

  • 3+ years of nursing experience in a managed care setting.
  • IPA or Health Plan experience
  • Background in Medicare Managed Care.
  • Experience with utilizing clinical criteria such as Milliman, InterQual, CMS National and Local Coverage Determinations (LCD).
  • Associates or Bachelor’s degree in Nursing.
  • Strong critical thinking and problem-solving skills.
  • Excellent communication and interpersonal abilities.
  • Comfortable working in a fast-paced environment with multiple priorities.
  • Proficiency in Microsoft Word, Excel, and Outlook.

What We Offer

  • Remote position – work from home with a California license.
  • Competitive compensation (range dependent on location and experience).
  • Comprehensive benefits package, including:
  • Medical, dental, and vision insurance.
  • 401(k) retirement plan with employer contributions.
  • Paid time off, personal days, and holidays.
  • Life insurance and disability coverage.
  • Ongoing training and career development opportunities.

Benefits:

  • 401(k)
  • Dental insurance
  • Health insurance
  • Retirement plan
  • Vision insurance

Company Description

Dragonfly Recruiting was founded with a vision to revolutionize the staffing industry. From our humble beginnings, we have grown into a trusted partner for businesses and job seekers alike. Our journey began with a small team of passionate recruiters who believed in the power of personalized service and the importance of building strong relationships.
Recently, we have expanded our services and our team, always staying true to our core values of integrity, excellence, and commitment to quality. Our growth has been driven by our dedication to understanding the unique needs of our clients and candidates, and our ability to adapt to the ever-changing landscape of the job market.
Dragonfly Recruiting is proud to be a leader in the staffing industry, known for our innovative solutions and our unwavering commitment to helping businesses and individuals achieve their goals.