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Remote Utilization Review Rn Jobs in Fairfield, CA

Baba

Virtual Nurse Practitioner

San Francisco, CA · Remote

Telehealth Nurse Practitioner | Remote 1099 | Structured Intake & Care Navigation About Baba Baba ... Active Nurse Practitioner or APRN license, in good standing - licensed in multiple states ...

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Remote Utilization Review Rn information

See Fairfield, CA salary details

$21

$43

$70

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 Fairfield, CA is $43.03, according to ZipRecruiter salary data. Most workers in this role earn between $33.99 and $49.42 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 Fairfield, CA? For Remote Utilization Review Rn jobs in Fairfield, CA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Fairfield, CA look for? The top searched job categories for Remote Utilization Review Rn jobs in Fairfield, CA are:
What cities near Fairfield, CA are hiring for Remote Utilization Review Rn jobs? Cities near Fairfield, 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 Fairfield, CA as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, and 4% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $89,502 per year, or $43 per hour.

Case Management Leader - Fully Remote | Upto $150/hr

Mercor

San Francisco, CA • Remote

$150/hr

Full-time

Re-posted 7 days ago

Job description

About the job

Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst, Peter Thiel, Adam D'Angelo, Larry Summers, and Jack Dorsey.

Position: Utilisation Management / Case Management leader (RN/Physician-advisor)
Type: Contract
Compensation: $100–$150/hour
Location: Remote

Role Responsibilities

  • Lead utilisation management and case management operations, including concurrent review, retrospective review, discharge planning, and care coordination.
  • Evaluate AI-generated medical necessity determinations and clinical review outputs for accuracy and clinical appropriateness.
  • Conduct and oversee clinical reviews against InterQual, MCG, or Milliman care guidelines to support admission and level-of-care determinations.
  • Manage the physician advisor program to support complex UM cases, peer-to-peer review requests, and denial appeals.
  • Coordinate with clinical teams, payers, and post-acute providers to facilitate appropriate care transitions and discharge planning.
  • Annotate AI outputs and provide structured clinical feedback to support AI training datasets.

Qualifications

Must-Have

  • 5+ years of experience in utilisation management, case management, or clinical review, with at least 2 years in a leadership role.
  • Active clinical licensure (RN required; physician advisor/MD preferred) with strong medical necessity review expertise.
  • Deep knowledge of InterQual, MCG, or Milliman clinical review criteria.
  • Expertise in CMS Two-Midnight Rule, observation status regulations, and inpatient criteria.
  • Experience managing physician advisor programs and peer-to-peer review processes with payers.
  • Exceptional written and verbal English communication skills.
  • High attention to detail with the ability to critically evaluate clinical documentation and AI-generated UM outputs.

Preferred

  • CPUR, ACM, or CCM credential.
  • MD or DO with UM/physician advisor experience preferred for physician advisor roles.
  • Experience with UM software platforms (Allscripts, Utilisation Management software, or equivalent).
  • Familiarity with AI tools and comfort evaluating AI-generated clinical review content.
  • Background in health system, ACO, or value-based care organisation UM programs.

Resources & Support

  • For details about the interview process and platform information, please check: https://talent.docs.mercor.com/welcome
  • For any help or support, reach out to: support@mercor.com

PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.