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

Imh

RN Care Manager

West Covina, CA · Remote

$41.20 - $62.17/hr

Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...

Inspire Healthcare

Medical Director Physician

Pomona, CA · Remote

$250K - $350K/yr

We are seeking a Remote Medical Director for a non-clinical role focused on prior authorization and ... Review prior authorization requests and determine medical necessity using evidence-based clinical ...

Moffitt

PATIENT OBSERVER PRN

Long Beach, CA · Remote

$16.75/hr

... (RN) of assigned patients. Observation may include more than one patient at a time at the remote ... We are committed to maintaining fair and equitable pay practices and regularly review compensation ...

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Remote Utilization Review Rn information

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$22

$45

$74

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

As of Aug 7, 2026, the average hourly pay for remote utilization review rn in Irvine, CA is $45.39, according to ZipRecruiter salary data. Most workers in this role earn between $35.87 and $52.12 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 Irvine, CA? For Remote Utilization Review Rn jobs in Irvine, CA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Irvine, CA look for? The top searched job categories for Remote Utilization Review Rn jobs in Irvine, CA are:
What cities near Irvine, CA are hiring for Remote Utilization Review Rn jobs? Cities near Irvine, 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 Irvine, CA as of August 2026, with employment types broken down into 87% Full Time, and 13% Part Time. Highlights an 100% Remote job distribution, with an average salary of $94,401 per year, or $45.4 per hour.

Quality Review RN : Hospice

Hoag Memorial Hospital Presbyterian

Newport Beach, CA • On-site, Remote

Full-time

Posted 7 days ago

Hoag Memorial Hospital Presbyterian rating

8.3

Company rating: 8.3 out of 10

Based on 78 frontline employees who took The Breakroom Quiz

79th of 1,055 rated hospitals

Job description


Primary Duties and Responsibilities
  • The Quality Management (QM) Nurse is responsible for preparing, reviewing, and presenting findings on all potential quality management events reported to the department and all grievances submitted to the Medical Director, Health Plan (HP) and/or Quality Management Committee (QMC) based upon department policies and procedures.
  • Depending on each Health Plan's reporting requirements, the QM Nurse reviews all submitted grievances, supporting documentation and prepares a response to the Health Plan partners for their review and determination.
  • The QM Nurse tracks the activities related to the grievance until the Health Plan releases a final determination.
  • The QM Nurse documents all activities in the Quality Management System for monitoring and Committee reporting.
  • The QM Nurse participates in any quality management projects as assigned.
  • The QM Nurse assists in the coordination and collection of HEDIS medical records, identifies potential gaps in care/quality of care, provides recommendations to the committee on resolving gaps identified and conducts assigned department audits as appropriate.
  • The role involves a high level of data collection, intensive patient care review, and implementing process improvement activities.
  • This position participates in the QMC by providing the QM activity reports to the committee.
  • Other duties as assigned.

Qualifications
Education and Experience
  • At least 3 to 5 years of Nursing Experience in a Medical Group, Hospital, Health Plan or Risk Based MSO setting.
  • Experience with Medicare/Medicare Advantage Plans, Commercial Plans, HMO, and/or Medi-Cal/ACA standards.
  • Must have 2 to 3 years of Quality or Peer review responsibility.
  • Bachelor's degree in a health care related field preferred.
License Required
Registered Nurse (RN) in the State of California
License Preferred
N/A
Certifications Required
N/A
Certifications Preferred
N/A
About Us
Hoag Memorial Hospital Presbyterian is a nonprofit regional health care delivery network in Orange County, California, consisting of three acute-care hospitals with sixteen urgent care centers, eleven health centers and a network of more than1,800 physicians, 100 allied health members, 8,000 employees, and 2,000 volunteers. More than 30,000 inpatients and 550,000 outpatients choose Hoag each year.
For over 70 years, Hoag has delivered a level of personalized care that is unsurpassed among Orange County's health care providers. Since 1952, Hoag has served the local communities and continues its mission to provide the highest quality health care services through the core strategies of quality and service, people, physician partnerships, strategic growth, financial stewardship, community benefit and philanthropy.
Hoag offers a comprehensive blend of health care services including six institutes providing specialized care in the areas of cancer, heart and vascular, neurosciences, women's health, orthopedics, and digestive health through our institutes.
Hoag was the highest ranked hospital in Orange County in the 2024-2025 U.S. News &World Report, the only Orange County hospital ranked in the top 10 for California. The organization was ranked the #5 hospital in the Los Angeles Metro Area and the #10 hospital in California.
To learn more about Hoag's awards and accreditations, visit: https://www.hoag.org/about-hoag/awards-accreditations/.
Hoag is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. Hoag is committed to the principle of equal employment opportunity for all employees and providing employees with a work environment free of discrimination and harassment. Hoag hires a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives.

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About Hoag Memorial Hospital Presbyterian

Sourced by ZipRecruiter

Hoag Memorial Hospital Presbyterian, located in Newport Beach, CA, US, is a leading health care provider within the healthcare industry. Their official website is hoag.org. Hoag is a nonprofit, regional health care delivery network in Orange County, California, that treats over 30,000 inpatients and 450,000 outpatients annually. Founded in 1952, the hospital has stood as a pillar of health in the community for over six decades. Committed to providing the highest quality care to patients, Hoag offers a range of comprehensive services including cancer care, women's health services, heart and vascular service, orthopedics, neurosciences and spine care.

Industry

Hospitals

Company size

5,001 - 10,000 Employees

Headquarters location

Newport Beach, CA, US

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