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Remote Utilization Review Rn Jobs in Elk Grove, CA

Corvel

Professional Review Nurse

Folsom, CA · Remote

$70K - $85K/yr

This is a remote position in CA. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Identify the necessity ... Must maintain current licensure as a Registered Nurse in the state of employment with a minimum of ...

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Remote Utilization Review Rn information

See Elk Grove, CA salary details

$22

$44

$72

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

As of Jul 27, 2026, the average hourly pay for remote utilization review rn in Elk Grove, CA is $44.45, according to ZipRecruiter salary data. Most workers in this role earn between $35.14 and $51.06 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 Elk Grove, CA? For Remote Utilization Review Rn jobs in Elk Grove, CA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Elk Grove, CA look for? The top searched job categories for Remote Utilization Review Rn jobs in Elk Grove, CA are:
What cities near Elk Grove, CA are hiring for Remote Utilization Review Rn jobs? Cities near Elk Grove, 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 Elk Grove, CA as of July 2026, with employment types broken down into 89% Full Time, 8% Part Time, and 3% Contract. Highlights an 40% Physical, 3% Hybrid, and 57% Remote job distribution, with an average salary of $92,455 per year, or $44.4 per hour.
Authorization Nurse, RN - Hybrid (Remote Considered) - 26-88

Authorization Nurse, RN - Hybrid (Remote Considered) - 26-88

Hill Physicians Medical Group

Sacramento, CA • On-site, Remote

$100K - $123K/yr

Full-time

Posted 6 days ago

Job description

We're delighted you're considering joining us!
At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.
Join Our Team!
Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the "Best Places to Work in the Bay Area" and have been recognized as one of the "Healthiest Places to Work in the Bay Area." When you join our team, you're making a great choice for your professional career and your personal satisfaction.
DE&I Statement:
At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.
We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!
Job Description:
The Authorization Nurse is responsible for the evaluation of medical appropriateness and necessity for a variety of services using contracts, medical policies, and evidence-based clinical guidelines while also ensuring benefit and eligibility requirements are met. They work with physician reviewers and providers to meet the health care needs of members so that they can receive efficient and timely medical care.
Job Responsibilities:
  • Review and process urgent and non-urgent authorization requests (received via phone, fax and electronic submission) for medical necessity (according to established criteria) and authorize, pend or modify as appropriate.
  • Process authorization requests (routine, urgent and retrospective) according to regulatory requirements.
  • Utilize a variety of medical necessity, contractual and benefit criteria to determine appropriate authorization decisions. Criteria may include MCG, Hill Guidelines, Health Plan Criteria, Health Plan and Hill Physician contracted provider data and member benefit information.
  • Obtain additional medical information as necessary from requesting provider.
  • Communicate with providers and members regarding status of authorization requests.
  • Assist interdepartmental staff members to resolve issues relating to the authorization process.
  • Refer information regarding members to other departments as appropriate for follow-up (i.e., Case Management, Health Education, TPL, COB).
  • Ensure quality authorization processing while meeting individual and team productivity standards.
  • Clearly and succinctly document necessary and/or required information in Epic Tapestry system.
  • Utilize critical thinking skills to identify process issues and problems and recommend and/or implement solutions.
  • Prepare and present cases to physician reviewers/UM Medical Director in a concise, objective and organized manner.
  • Collaborate with physician reviewers, Utilization Management Medical Director and other designated physician leaders on making clinical decisions.
  • Participate in on-call or alternate work hour programs as needed to meet regulatory compliance requirements.
  • Perform other duties as assigned by supervisor/manager.

Skills and Experience Required:
  • Active, unrestricted California Licensure: Registered (RN) or Licensed Vocational Nurse (LVN).
  • Bachelor's degree in nursing strongly preferred
  • Minimum 3 or more years pertinent experience in Managed Care Utilization Management
  • Experience with medical decision supports tools such as MCG.
  • Previous experience with Epic Tapestry platform preferred but not required.
  • Knowledge of ICD-10 and CPT coding.
  • Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point)
  • Excellent verbal and written communication skills.
  • Ability to work effectively with a variety of customers including physicians, office staff, and members.
  • Demonstrated organization and time management skills with the ability to prioritize workload and meet expected and unexpected time frames.
  • Strong analytical and critical thinking skills.
  • Ability to take action in solving problems exhibiting sound judgement.
  • Demonstrated comfort with ambiguity and change.
  • Ability to work independently with self-initiative and discipline.
  • Adaptable/flexible -- enjoys doing work that requires frequent shifts in direction
  • Detail-oriented -- would rather focus on the details of work than the bigger picture
  • High stress tolerance -- thrives in a high-pressure environment
  • Demonstrated critical thinking and inquisitiveness in reviewing UM cases for appropriate global review and decision-making.

Additional Information:
Salary: $100,000 - $123,000 Annual
Location: Hybrid (Sacramento or San Ramon) - Remote Considered
Hill Physicians is an Equal Opportunity Employer

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