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Remote Utilization Review Rn Jobs in Rancho Santa Fe, CA

sycuan

Clinical Application Coordinator

El Cajon, CA · On-site +1

Monitor clinical efficiency and system utilization to recommend enhancements. * Incorporate user ... Telephone and remote troubleshooting * Quality focus * Flexible and able to work in a unique ...

Integrated Resources INC

Case Manager - Remote

San Diego, CA · Remote

$21.25 - $27.25/hr

Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing. This is a TEMP ... The manager is flexible with a 30 or 60 minute typical day will consist of scheduling reviews that ...

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Remote Utilization Review Rn information

See Rancho Santa Fe, CA salary details

$23

$46

$76

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

As of Jun 8, 2026, the average hourly pay for remote utilization review rn in Rancho Santa Fe, CA is $46.90, according to ZipRecruiter salary data. Most workers in this role earn between $37.07 and $53.85 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 cities near Rancho Santa Fe, CA are hiring for Remote Utilization Review Rn jobs? Cities near Rancho Santa Fe, 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 Santa Fe, CA as of May 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $97,560 per year, or $46.9 per hour.
Program Manager, Healthcare Services (Enhanced Care Mgmt - PST hours)

Program Manager, Healthcare Services (Enhanced Care Mgmt - PST hours)

Molina Healthcare

San Diego, CA • Remote

$84K - $163K/yr

Full-time

Posted 18 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 192 frontline employees who took The Breakroom Quiz

145th of 260 rated insurance

Job description

JOB DESCRIPTION Job Summary

Provides subject matter expertise and leadership to healthcare services function - providing support for project/program/process design, execution, evaluation and support, and ensuring compliance with regulatory and internal standards, practices, policies and contractual commitments. Contributes to overarching strategy to provide quality and cost-effective member care. 

Essential Job Duties

 Collaboratively plans and executes internal healthcare services projects and programs involving department or cross-functional teams of subject matter experts - delivering products from the design process to completion. 
Provides ongoing communication related to program goals, evaluation and support to ensure compliance with standardized protocols and processes. 

 May engage and oversee the work of external vendors. 

 Focuses on process improvement, organizational change management, program management and other processes relative to business needs. 

 Serves as a subject matter expert and leads healthcare services programs to meet critical needs. 

 Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements. 
Conducts quality audits to assess healthcare services staff educational needs and service quality, and implements quality initiatives within the department as appropriate. 

 Creates business requirements documents (BRDs), test plans, requirements traceability matrix (RTMs), user training materials and other related business documents. 

Required Qualifications

At least 5 years of health care experience, including experience in clinical operations, and at least 3 or more years in one or more of the following areas: utilization management, care management, care transitions, behavioral health, or equivalent combination of relevant education and experience. 
Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC) or Licensed Marriage and Family Therapist (LMFT).  Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates.   If licensed, license must be active and unrestricted in state of practice. 
Strong analytical and problem-solving skills.
Strong organizational and time-management skills.
Ability to work in a cross-functional, professional environment.
Experience working within applicable state, federal, and third-party regulations.
Strong verbal and written communication skills. 
Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases.
Preferred Qualifications

      Knowledge of CalAIM (ECM or CS)

  • Strong analytical skills
  • Project management experience
  • Strong attention to detail
  • Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM),  Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification. 
  • Leadership experience. 
    Medicaid/Medicare population experience. 

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $84,067 - $163,931 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

What Molina Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

Social media

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