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

Molina Healthcare

RN Care Manager - STARS

Fresno, CA · Remote

$30.37 - $59.21/hr

This is a 100% remote role. Must be an RN and reside in California. Job Summary Provides support for care management/care coordination activities and collaborates with multidisciplinary team ...

IQVIA

Flex Nurse Educator

Fresno, CA · Remote

Deliver remote patient education, including medication administration training and adherence ... Active RN license in good standing (compact multi-state preferred); may be required to obtain ...

IQVIA

Flex Nurse Educator - Fresno, CA

Fresno, CA · Remote

Deliver remote patient education, including medication administration training and adherence ... Active RN license in good standing (compact multi-state preferred); may be required to obtain ...

BillionToOne

Oncology Account Executive

Fresno, CA · Remote

$241K - $311K/yr

Physicians Assistant (PA), Nurse Practitioner (NP) or Registered Nurse (RN) with experience ... LI-Remote For more information about how we protect your information, we encourage you to review ...

BillionToOne

Oncology Account Executive

Fresno, CA · Remote

$241K - $311K/yr

Physicians Assistant (PA), Nurse Practitioner (NP) or Registered Nurse (RN) with experience ... LI-Remote For more information about how we protect your information, we encourage you to review ...

Veterans Health Administration

NURSE ANESTHETIST

Fresno, CA · On-site +1

$161K - $234K/yr

... review of the EDRP application. Former EDRP participants ineligible to apply. Learn more about this agency Duties Help The CRNA administers anesthesia in both inpatient and outpatient settings to ...

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Remote Utilization Review Rn information

See Fresno, CA salary details

$21

$41

$68

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

As of Aug 29, 2026, the average hourly pay for remote utilization review rn in Fresno, CA is $41.98, according to ZipRecruiter salary data. Most workers in this role earn between $33.17 and $48.22 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 Fresno, CA?

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

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

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

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

Cities near Fresno, 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 Fresno, CA as of August 2026, with employment types broken down into 6% As Needed, 72% Full Time, 11% Part Time, and 11% Contract. Highlights an 100% Remote job distribution, with an average salary of $87,323 per year, or $42 per hour.

RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)

Fresno, CA • Remote

Molina Healthcare
Health Care and Social Assistance • 10K+ employees

8.0

Company rating: 8.0 out of 10

Based on 199 frontline employees who took The Breakroom Quiz

169th of 314 rated insurance

People enjoy working here

Good employer

Recommended by students

Learn more about Molina Healthcareexternal

$30.37 - $59.21/hr

Full-time

Re-posted 15 days ago

Job description

JOB DESCRIPTION Job Summary

Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. 
Essential Job Duties 
• Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. 
• Analyzes clinical service requests from members or providers against evidence based clinical guidelines. 
• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. 
• Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. 
• Processes requests within required timelines. 
• Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. 
• Requests additional information from members or providers as needed. 
• Makes appropriate referrals to other clinical programs. 
• Collaborates with multidisciplinary teams to promote the Molina care model. 
• Adheres to utilization management (UM) policies and procedures. 
Required Qualifications 
• At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. 
• Registered Nurse (RN). License must be active and unrestricted in state of practice. 
• Ability to prioritize and manage multiple deadlines. 
• Excellent organizational, problem-solving and critical-thinking skills. 
• Strong written and verbal communication skills. 
• Microsoft Office suite/applicable software program(s) proficiency. 
Preferred Qualifications 
Certified Professional in Healthcare Management (CPHM). 

Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $30.37 - $59.21 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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Benefits

Hours and flexibility

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