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

Gallagher

Vice President, PRIME Managed Care

Anaheim, CA · Remote

$145K - $185K/yr

... utilization review, and nurse case management functions. The Vice President will lead and support ... Active California RN license preferred. Behaviors: Demonstrated verbal and written communications ...

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 ...

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 ...

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

See Irvine, CA salary details

$22

$45

$74

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

As of Jul 15, 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, 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 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 July 2026, with employment types broken down into 64% Full Time, 9% Part Time, and 27% Contract. Highlights an 100% Remote job distribution, with an average salary of $94,401 per year, or $45.4 per hour.
Utilization Management Nurse I, RN

Utilization Management Nurse I, RN

Clever Care Health Plan

Huntington Beach, CA • Remote

$34.98 - $42.85/hr

Full-time

Posted 8 days ago

Job description

Remote in California only

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.   

Who Are We?  

Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values. 

Why Join Us?  

We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation. 

Job Summary

The UM Nurse I - RN performs clinical review of authorization requests to determine medical necessity based on established criteria, regulatory requirements, and organizational policies. This role conducts utilization review activities under established guidelines and escalates complex or non-standard determinations to senior staff or the Medical Director.

Functions & Job Responsibilities

· Conduct clinical review of prior authorization requests using approved criteria (e.g., MCG, InterQual).

· Review outpatient and routine inpatient requests.

· Ensure compliance with CMS, state, and contractual turnaround time requirements.

· Document medical necessity determinations clearly and accurately.

· Communicate authorization decisions to providers, members and internal teams.

· Identify cases requiring physician or Medical Director review.

· Participate in concurrent review and discharge planning coordination as assigned.

· Ensure compliance with regulatory timelines.

· Support audit readiness and documentation integrity.

· Additional duties as assigned.

Qualifications

Education and Experience

· Active, unrestricted RN license.

· Minimum of three (3) years of clinical experience.

· At least one (1) year in utilization management or case management preferred.

Skills

· Knowledge of medical necessity criteria (MCG/InterQual).

· Understanding of CMS/state UM regulations.

· Strong clinical assessment and documentation skills

· Ability to manage caseload efficiently.

· Effective provider communication.

· Bilingual proficiency in Cantonese, Mandarin, Spanish, Vietnamese, or Korean preferred.

Wage Range: $34.98 to $42.85 per hour

Physical & Working Environment.

Physical requirements needed to perform the essential functions of the job, with or without reasonable accommodation:

• Must be able to travel when needed or required

• Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking)

• Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs. Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly. Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. May occasionally be required to work irregular hours based on the needs of the business.

Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required. 

  

Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency. 

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