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Remote Utilization Review Rn Jobs in Rancho Cucamonga, CA

BillionToOne

Oncology Account Executive

Riverside, 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

Riverside, 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 ...

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

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 ...

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All JobsUtilization Review Rn JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in Rancho Cucamonga, CA

Remote Utilization Review Rn information

See Rancho Cucamonga, CA salary details

$21

$43

$70

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

As of Aug 23, 2026, the average hourly pay for remote utilization review rn in Rancho Cucamonga, CA is $43.21, according to ZipRecruiter salary data. Most workers in this role earn between $34.13 and $49.62 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 Rancho Cucamonga, CA?

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

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

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

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

Cities near Rancho Cucamonga, 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 Rancho Cucamonga, CA as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, 2% Contract, and 1% Nights. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution, with an average salary of $89,874 per year, or $43.2 per hour.

CA Based Licensed Nurse Care Manager, Adult

Included Health

Corona, CA • Remote

$35.43 - $50/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 18 days ago

Included Health rating

7.6

Company rating: 7.6 out of 10

Based on 17 frontline employees who took The Breakroom Quiz

192nd of 495 rated business services

Job description

We're looking for California Based Nurse Care Managers for our Care and Case Management team, who resides in California and holds a CA RN license; have experience working with a health plan, health navigator or third-party administrator (TPA). Are passionate about caring for members holistically through their healthcare journey and ensuring needs are met with industry-leading interventions. As a telephonic Nurse Care Manager you will report to the Manager, Care and Case Management and will guide members through complex medical and behavioral Health situations, partnering with a diverse clinical team that includes a variety of healthcare professionals, care coordinators, and records specialists, to deliver integrated remote care in a creative way. The Nurse Care Manager should enjoy spending time on the phone, listening to members' needs, answering questions, and serving as an advocate. You will excel at creating cohesive care plans, and have the clinical skills to guide members clinically and navigate available benefits and resources. Nurse Care Managers will support members through complex care management, disease management, and acute case management, ensuring they receive longitudinal care that results in excellent health outcomes.
#LI-Remote
Responsibilities:
  • Deliver coordinated, patient-centered virtual Care Management by telephone or video that improves members' health outcomes.
  • Create impactful care plans together with members and our diverse care team, and help members achieve the desired goals.
  • Help members navigate complex medical conditions, treatment pathways, benefits, and the healthcare system in general.
  • Partner with the members' local providers to ensure coordinated care.
  • Provide compassionate, longitudinal follow-up care, building supportive relationships.
  • Assist throughout acute healthcare episodes, such as hospitalizations and rehabilitation stays, providing coordinated Case Management to support the member and their family.
  • Coordinate necessary resources that holistically address members' problems, whether clinical or social
Qualifications:
  • Bachelor of Science in Nursing (BSN).
  • 5+ years of experience in nursing
  • 2+ years experience working in care management
  • Must reside and be based in California
  • Active California Nursing License
  • Willingness to become (and maintain) licensure in multiple states.
  • Work schedule 9AM-6pm PST
  • Be comfortable discussing several medical conditions and experience with populations across the age ranges
  • Spanish speaking desirable
  • Experience working remotely, and strong competence and ability to use multiple computer/medical record systems.
  • Be empathetic. We work with patients and their families who are going through challenging times. You practice empathy and reassure patients that we are available to help them.
  • We are a fast-growing company and we are busy. Our team will meet volume goals without sacrificing quality.
  • Strictly follow security and HIPAA regulations to protect our patients' medical information.
  • Be pleasant, responsive, and willing to work with and learn from our team.
  • A lot of time is spent on the phone with patients and families, and a lot of time communicating with colleagues. Therefore, the ability to gather a clinical history, answer questions at a patient level, and summarize findings is critical.
  • Efficient at writing medical information in easy-to-understand, patient-centric language.
Physical/Cognitive Requirements
  • Prompt and regular attendance at assigned work location.
  • Capability to remain seated in a stationary position for prolonged periods.
  • Eye-hand coordination and manual dexterity to operate keyboard, computer and other office-related equipment.
  • No heavy lifting is expected, though occasional exertion of about 20lbs of force (e.g., lifting a computer \/ laptop) may be required.
  • Capability to work with leadership, employees, and members in an appropriate manner.
The United States new hire hourly salary target range for this full-time position is:
$35.43 - $50 per hour + equity + benefits
 
This range reflects the minimum and maximum target for new hire salaries for candidates. Below is additional information on Included Health's commitment to maintaining transparent and equitable compensation practices across our distinct geographic zones.
 
Starting base salary for the successful candidate will depend on several job-related factors, unique to each candidate, which may include, but not limited to, education; training; skill set; years and depth of experience; certifications and licensure; business needs; internal peer equity; organizational considerations; and alignment with geographic and market data. Compensation structures and ranges are tailored to each zone's unique market conditions to ensure that all employees receive fair and competitive compensation based on their roles and locations. Your Recruiter can share your geographic zone alignment upon inquiry.
 
 
In addition to receiving a competitive base salary, the compensation package may include, depending on the role, the following:
 
Remote-first culture
401(k) savings plan through Fidelity
Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance)
Full suite of Included Health telemedicine (e.g. behavioral health, urgent care, etc.) and health care navigation products and services offered at no cost for employees and dependents
Generous Paid Time Off ("PTO") and Discretionary Time Off ("DTO")
12 weeks of 100% Paid Parental leave
Family Building Benefit with fertility coverage and up to $25,000 for Surrogacy & Adoption financial assistance
Compassionate Leave (paid leave for employees who experience a failed pregnancy, surrogacy, adoption or fertility treatment)
11 Holidays Paid with one Floating Paid Holiday
Work-From-Home reimbursement to support team collaboration and effective home office work
24 hours of Paid Volunteer Time Off ("VTO") Per Year to Volunteer with Charitable Organizations.

About Included Health

Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We're on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community - no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It's all included. Learn more at includedhealth.com.

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Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants with arrest or conviction records in accordance with the San Francisco Fair Chance Ordinance, the Los Angeles County Fair Chance Ordinance, and California law.
Included Health uses AI-assisted tools at select stages of the hiring process to enhance efficiency, consistency, and communication. AI does not make hiring decisions-final decisions are made exclusively by our recruiting and hiring teams.
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