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

Sonendo Inc

Area Sales Representative

Laguna Hills, CA · Remote

$40K - $50K/yr

Remote (Bay Area, Seattle, NYC) Division/Department: Commercial / Sales Reports to: Area Sales ... utilization of their practice including business and clinical needs. * Execute business reviews ...

Ensign Services, Inc.

Managed Care Resource

Whittier, CA · On-site +1

$110K - $130K/yr

The Managed Care Consultant supports the Skilled Nursing Facility leaders in managed care ... Assess resource utilization, cost management and negotiate effectively. * Monitor industry changes ...

Ensign Services, Inc.

Managed Care Resource

Long Beach, CA · On-site +1

$110K - $130K/yr

The Managed Care Consultant supports the Skilled Nursing Facility leaders in managed care ... Assess resource utilization, cost management and negotiate effectively. * Monitor industry changes ...

Ensign Services, Inc.

Managed Care Resource

Pomona, CA · On-site +1

$110K - $130K/yr

The Managed Care Consultant supports the Skilled Nursing Facility leaders in managed care ... Assess resource utilization, cost management and negotiate effectively. * Monitor industry changes ...

Glaukos

Field Reimbursement Director

San Clemente, CA · Remote

Lead Performance Reviews, including ride-alongs/co-travel to provide expertise and coaching: in ... policy, utilization management criteria, prior authorization processes and appeal requirements.

Glaukos

Field Reimbursement Director

San Clemente, CA · Remote

Lead Performance Reviews, including ride-alongs/co-travel to provide expertise and coaching: in ... policy, utilization management criteria, prior authorization processes and appeal requirements.

NANO BANC

Chief Credit Officer

Irvine, CA · On-site +1

$300K - $375K/yr

... loan reviews, credit software utilization, stress testing, and risk management - particularly ... This position is primarily office-based, with no regular remote work. Some travel may be required ...

Qcells

Director of EPC Warranties

Irvine, CA · On-site +1

Hybrid/Remote DIRECTOR OF EPC WARRANTIES Hanwha Qcells USA Corp (Qcells USA), headquartered in ... Reviews and analyzes contract records to advice technical and Commercial SMEs to determine ...

NFP Corp

Senior Private Equity Broker

Santa Ana, CA · On-site +1

$205K - $273K/yr

Oversee the review of binders and policies for accuracy and alignment with negotiated terms ... utilization * Demonstrate a strong understanding of a variety of P&C risk financing strategies

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All JobsUtilization Review Rn JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in Irvine, CA

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 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.

Senior Director, Pharmacy

Centene Pharmacy Services

La Palma, CA • On-site, Remote

$185K - $352K/yr

Full-time, Part-time

Medical, Retirement, PTO

Posted 15 days ago

Job description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Manage all aspects of pharmacy operations in two markets with multiple products. Perform duties to develop, direct and implement a pharmacy benefit management program. Aid in formulating and administering related organizational policies and procedures, including pharmacy service quality, pharmacy utilization management and achievement of Company goals for pharmacy and medical programs.
  • Establish the strategic vision, objectives and policies and procedures for the pharmacy program in support of the Corporate strategic vision for multiple plans and markets.
  • Plan, direct and implement pharmacy activities for multiple plans and products.
  • Act as the pharmacy contract administrator for the development and implementation of key contracts and ensure that relevant performance standards are met by vendors.
  • Participate in external accreditation initiatives for multiple plans and products.
  • Manage and analyze operating costs and participate in preparing materials needed for budget planning or special initiatives.
  • Generate, review and analyze drug utilization, utilization management, financial and other ad-hoc reports, records and directives. Confer with staff to obtain data required for planning work function activities.
  • Review statistical analysis in support of recommendations and/or decision making for policies and operational procedures.
  • Maintain daily communication with plan management relative to each market and product.
  • Manage pharmacy department staff to assure adequate coverage and support in multiple locations and for multiple products.
  • Support provider education initiatives such as counter detailing and incentive programs in multiple markets.
Education/Experience: Bachelor’s degree in Pharmacy or advanced pharmacy degree (PharmD., M.S.) from an accredited college of pharmacy. 6+ years of clinical pharmacy care experience. 1+ years of experience managing a pharmacy program. Managed care, retail or hospital pharmacy experience required. Thorough knowledge of pharmaceutical care and pharmacy benefit management practices. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
Licenses/Certifications: Current Pharmacist license. Ability to receive license in additional states as required. Valid driver's license.Pay Range: $185,700.00 - $352,500.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.


Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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PandoLogic. Keywords: Pharmacy Director, Location: La Palma, CA - 90623

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