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Remote Utilization Review Rn Jobs in Los Angeles, CA

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Remote Utilization Review Rn information

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

As of Aug 18, 2026, the average hourly pay for remote utilization review rn in Los Angeles, CA is $45.56, according to ZipRecruiter salary data. Most workers in this role earn between $36.01 and $52.31 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 the most commonly searched types of Utilization Review Rn jobs in Los Angeles, CA?

The most popular types of Utilization Review Rn jobs in Los Angeles, CA are:

What are popular job titles related to Remote Utilization Review Rn jobs in Los Angeles, CA?

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

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

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

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

Cities near Los Angeles, 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 Los Angeles, CA as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $94,763 per year, or $45.6 per hour.

Medical Director Utilization Management Oncology

The Oncology Institute of Hope and Innovation

Cerritos, CA • Remote

$275K - $325K/yr

Full-time

Re-posted 2 days ago

Job description

Starling Oncology (NASDAQ: STLN) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. Formerly known as The Oncology Institute, Starling Oncology offers cutting-edge, evidence-based cancer care to a population of approximately 2.1 million patients, including clinical trials, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With more than 400 employed and network clinicians and over 100 clinics and network locations of care across five states and growing, Starling Oncology is changing oncology for the better. For more information, visit www.starlingoncology.com.

Utilization Management Medical Director Oncology

Work Location: REMOTE (work from home)

California Nevada Arizona Oregon Florida

The Medical Director role provides clinical expertise in assessing the medical necessity, appropriateness, and efficiency of oncology care with a focus on direct utilization management for case review and clinical decision making.

In this collaborative role, you will work with physicians, clinical teams and operational leaders to support evidence-based high quality and cost-effective care delivery across the network. You will also contribute to cross-functional initiatives, data-driven insights, and oversight of utilization management policies to optimize patient outcomes.

 Key Responsibilities:

  • Conduct medical reviews and make independent clinical decisions of hematology and oncology treatment plans to determine medical necessity, appropriateness, and alignment with value-based clinical guidelines and evidence-based practices.
  • Review and assess the appropriateness of ongoing cancer treatment plans, ensuring that they align with evidence-based medicine and clinical best practices.
  • Provide clinical guidance and recommendations that balance quality, outcomes, and cost-effectiveness.
  • Liaise with providers, insurance companies, and patients to clarify and discuss treatment options and coverage.
  • Evaluate clinical and utilization data to identify trends, variations in care, and opportunities for improvement
  • Partner with clinical and operational teams to support value-based care.
  • Ensure compliance with organizational policies, regulatory standards, and payer requirements in all clinical decisions.
  • Participate in the development and continuous improvement of utilization management protocols and criteria specific to oncology.

Qualifications:

  • Medical degree (MD or DO)
  • Board Certification in Oncology.
  • Minimum of 5 years of clinical experience in oncology.
  • 2+ years of Utilization Management experience
  • Proven expertise in Utilization Management or experience with reviewing clinical appropriateness of treatment plans.
  • Strong understanding of oncology-specific treatment protocols, guidelines, and reimbursement policies.
  • Excellent analytical skills and the ability to evaluate complex clinical data.
  • Ability to work independently and make evidence-based decisions in a collaborative, multidisciplinary setting.
  • Excellent communication skills to engage effectively with healthcare providers, payers, and patients.

If you're interested in learning more, but not ready to apply, please reach out to our team to set-up a call at your convenience. Physiciancareers@theoncologyinstitute.com

Ready to apply? Please complete the simple application and our team will reach out to you quickly.

The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role.

Pay Transparency for salaried teammates
$275,000—$325,000 USD