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Remote Utilization Review Rn Jobs in Redding, CA

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Remote Utilization Review Rn information

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$22

$44

$73

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

As of Jul 26, 2026, the average hourly pay for remote utilization review rn in Redding, CA is $44.99, according to ZipRecruiter salary data. Most workers in this role earn between $35.53 and $51.68 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 Redding, CA? For Remote Utilization Review Rn jobs in Redding, CA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Redding, CA look for? The top searched job categories for Remote Utilization Review Rn jobs in Redding, CA are:
What cities near Redding, CA are hiring for Remote Utilization Review Rn jobs? Cities near Redding, 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 Redding, CA as of July 2026, with employment types broken down into 69% Full Time, 14% Part Time, and 17% Contract. Highlights an 43% Physical, 3% Hybrid, and 54% Remote job distribution, with an average salary of $93,569 per year, or $45 per hour.
Clinical Quality Assurance Nurse Auditor (32604)

Clinical Quality Assurance Nurse Auditor (32604)

ExamWorks LLC

Redding, CA • On-site, Remote

$34 - $35/hr

Full-time

Posted yesterday

ExamWorks rating

7.8

Company rating: 7.8 out of 10

Based on 22 frontline employees who took The Breakroom Quiz

Job description

*** All candidates must reside in the Pacific Time Zone. You must also be a Registered Nurse (RN) with an active license and have ICU experience. ***
Why Join Us?
Are you a meticulous RN who loves diving into clinical data? Do you want to use your medical expertise outside of direct patient care to impact healthcare integrity?
As our Clinical Quality Assurance Nurse Auditor, you will be the final line of defense for medical accuracy and compliance. Your expertise ensures that clinical reports, medical record chronologies, and billing reviews are bulletproof, evidence-based, and of the highest professional standard. This is a high-impact role where your sharp clinical eye directly protects patients, providers, and healthcare standards.
What You Will Do (Your Impact)
  • Champion Report Excellence: Review and refine critical medical reports, chronologies, and provider bills to ensure flawless clinical accuracy and professional presentation.
  • Uphold Evidence-Based Medicine: Verify that every clinical determination is backed by robust, current citations from reputable medical journals.
  • Act as a Strategic Partner: Collaborate directly with reviewing physicians to clarify complex case details and resolve inconsistencies.
  • Guard Compliance & Integrity: Ensure full alignment with federal ERISA regulations, state mandates, and client specifications, while strictly verifying that no conflicts of interest exist.
  • Solve Problems Proactively: Help resolve client quality questions, recover missing medical data, and provide management with strategic insights on consultant performance.

What You Bring to the Team
  • Clinical Expertise: Active Registered Nurse (RN) license with strong clinical judgment.
  • A Sharp Eye for Detail: Exceptional proofreading, auditing, and analytical skills.
  • The Ability to Connect Dots: Deep understanding of medical coding, hospital billing, and record chronologies.
  • Regulatory Knowledge: Familiarity with state and federal healthcare mandates (like ERISA) is a massive plus.
  • Communication Skills: Ability to give constructive feedback to medical peers and providers with professionalism and clarity.

Organ donations
Organ Procurement
Intensive Care Unit (ICU)
MINIMUM REQUIRED QUALIFICATIONS
Education and/or Experience
Bachelor/Associate degree in nursing or related field; or minimum five years related experience; or equivalent combination of education and experience. Experience with medical terminology, medications, medical specialties and treatment protocols required. Experience in the insurance industry preferred.
Certificates, Licenses, Registrations
RN/LPN license
ESSENTIAL JOB FUNCTIONS
  • Evaluate clinical information received, write and/or review various reports including, but not limited to, Medical Record Reviews, Medical Record Chronologies, Provider Bill Reviews, Coding Reviews, Hospital Bill Reviews, List of Missing Records, Medical Bill Apportionments, Mock Billing Invoice and Medical Summary Statements.
  • Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
  • Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
  • Ensure that all client instructions and specifications have been followed and that all questions have been addressed.
  • Ensure each review is supported by clinical citations and references when applicable and verify that all references cited are current and obtained from reputable medical journals and/or publications.
  • Ensure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
  • Ensure the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.
  • Verify that the reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists.
  • Ensure the provider credentials and signature are adhered to the final report.
  • Identify any inconsistencies within the report and contacts the Reviewer to obtain clarification, modification or correction as needed.
  • Contact the appropriate person to recover any missing documentation or verify charges.
  • Assist in resolution of customer complaints and quality assurance issues as needed.
  • Ensure all federal ERISA or state mandates are adhered to at all times.
  • Provide insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.
  • Promote effective and efficient utilization of company resources.
  • Participate in various continuing education requirements and or training activities.
  • Perform other duties as assigned.

ExamWorks is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.
Equal Opportunity Employer - Minorities/Females/Disabled/Veterans

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About ExamWorks

Sourced by ZipRecruiter

ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Atlanta, GA, US

Year founded

2008

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