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

Astrana Health

UM Review Nurse - Remote

Monterey Park, CA · Remote

$34 - $47/hr

Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services ... This is a remote position for CA-licensed nurses. Candidates may reside in any state, but will be ...

Astrana Health, Inc.

UM Review Nurse

Monterey Park, CA · On-site +1

$34 - $47/hr

... Utilization Review Nurse to assist our Health Services Department. In this position, you will ... This is a remote position for CA-licensed nurses. Candidates must live in California. We are ...

Astrana Health

UM Review Nurse

Monterey Park, CA · Remote

$34 - $47/hr

Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services ... This is a remote position for CA-licensed nurses. Candidates must live in California. We are ...

Astrana Health, Inc.

UM Review Nurse

Monterey Park, CA · Remote

$34 - $47/hr

Description Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our ... This is a remote position for CA-licensed nurses. Candidates must live in California. We are ...

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All JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in Carson, CA

Remote Utilization Review Rn information

See Carson, CA salary details

$22

$44

$72

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

As of Jul 4, 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 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 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 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 Coordinator

Prosperous Health

Los Angeles, CA • Remote

Full-time

Medical, PTO

Posted 2 days ago

Be an early applicant

Job description

Salary: $70,000-$80,000 Anual DOE

Job Title: Utilization Review (UR) Coordinator

Company:Prosperous Billing / Prosperous Health
Department:Revenue Cycle / Clinical Operations Support
Employment Type:Full-Time (Remote or Hybrid, as applicable)

Position Summary

The Utilization Review (UR) Specialist at Prosperous Billing is responsible for securing, maintaining, and maximizing insurance authorizations for behavioral health and substance use disorder treatment services. This role serves as a key liaison between clinical teams and insurance payers to ensure medical necessity is clearly documented, authorizations are obtained in a timely manner, and continued stay approvals are optimized to support high-quality patient care and strong revenue cycle performance.

Key Responsibilities

Authorization & Continued Stay Management

  • Obtain initial and concurrent authorizations for detox, residential, PHP, IOP, and outpatient levels of care
  • Conduct continued stay reviews with insurance payers according to payer-specific timelines
  • Proactively track authorization expirations and submit reviews to prevent lapses in coverage or avoidable denials

Clinical Documentation & Medical Necessity

  • Review clinical documentation to ensure alignment with medical necessity criteria (ASAM, MCG, InterQual, and payer-specific guidelines)
  • Collaborate with clinical staff to obtain complete, accurate, and timely documentation
  • Summarize clinical information clearly and professionally for payer utilization reviews

Payer Communication & Appeals

  • Communicate directly with insurance reviewers, care managers, and medical directors
  • Participate in peer-to-peer reviews when necessary
  • Support appeals for denied or reduced authorizations through clinical summaries and supporting documentation

Revenue Cycle & Compliance Support

  • Maintain accurate authorization records within EMR and billing systems
  • Ensure compliance with payer contracts, regulatory requirements, and internal policies
  • Identify authorization-related risks and trends that may impact reimbursement or revenue integrity

Collaboration & Reporting

  • Work closely with billing, admissions, and clinical teams to ensure smooth authorization workflows
  • Provide regular reporting on authorization status, denials, approvals, and trends
  • Support ongoing process improvements to increase authorization success rates and reduce denials

Qualifications

Required

  • 2+ years of Utilization Review experience in behavioral health and/or substance use treatment
  • Strong working knowledge of ASAM criteria and medical necessity standards
  • Experience obtaining authorizations for residential and outpatient levels of care
  • Excellent verbal and written communication skills
  • Strong organizational skills with high attention to detail
  • Ability to manage multiple cases and deadlines simultaneously

Preferred

  • Clinical background (RN, LCSW, LMFT, LPCC, or equivalent licensure)
  • Experience working with commercial insurance payers and Medicaid plans
  • Familiarity with EMR systems and insurance payer portals
  • Prior experience in a billing, revenue cycle, or healthcare operations environment

Key Competencies

  • Medical necessity advocacy
  • Payer communication and negotiation
  • Clinical-to-financial alignment
  • Time management and prioritization
  • Critical thinking and problem-solving
  • Professional judgment and confidentiality

Compensation & Benefits

  • Competitive salary (commensurate with experience)
  • Health insurance coverage with50% employer contribution
  • Paid Time Off (PTO)
  • Paid holidays
  • Remote or hybrid work flexibility (role dependent)

Performance Metrics (Success Indicators)

  • Authorization approval rate
  • Timeliness of initial and continued stay submissions
  • Reduction in authorization-related denials
  • Accuracy and completeness of documentation
  • Responsiveness and collaboration with internal teams