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Remote Utilization Review Rn Jobs in Roseville, CA

Star Nursing, Inc.

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Case Manager - RN / Clinical Liaison

Sacramento, CA · Remote

$68K - $70K/yr

Remote - Home Base Clinical Liaison / Case Manager Position: * Work closely with the Director of ... Receiving, reviewing, and responding to concerns/complaints from clients, families, or POA and ...

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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 23, 2026, the average hourly pay for remote utilization review rn in Roseville, CA is $44.32, according to ZipRecruiter salary data. Most workers in this role earn between $35.05 and $50.91 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 Roseville, CA?

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

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

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

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

Cities near Roseville, 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 Roseville, CA as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 3% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $92,191 per year, or $44.3 per hour.

Health Care Professional - Utilization Review / First-Level Reviewer

Encompass Health Solutions, Inc

Sacramento, CA • Remote

$42 - $45/hr

Full-time

Posted 4 days ago

Job description

About Encompass

Encompass Workers' Comp Solutions is seeking a California-licensed healthcare professional to join our Utilization Review team as a Health Care Professional (HCP) / First-Level Reviewer.


This position may be filled by aLicensed Vocational Nurse (LVN), Registered Nurse (RN), or Doctor of Chiropractic (DC) with an active, unrestricted California license.


Founded by workers' compensation industry veterans, Encompass is committed to delivering objective, clinically sound services while fostering a professional, supportive, and employee-centered workplace.


About the Position

The Health Care Professional performs first-level utilization review of treatment authorization requests for injured workers. The HCP reviews clinical documentation and applies California's Medical Treatment Utilization Schedule (MTUS) and other applicable evidence-based guidelines to determine whether requested treatment meets criteria for authorization.


The HCP may approve treatment requests when applicable criteria are satisfied. Requests that cannot be approved at first-level review are prepared and referred to the appropriate Physician Reviewer.


The HCP does not modify or deny Requests for Authorization. All modification and denial decisions are made by Physician Reviewers.


What You'll Do

  • Review Requests for Authorization and supporting medical documentation for completeness.
  • Apply MTUS and other applicable evidence-based clinical guidelines.
  • Determine whether sufficient clinical information is available to complete the review and request additional information when necessary.
  • Make first-level review determinations within applicable regulatory timeframes.
  • Approve treatment requests when applicable criteria are satisfied.
  • Communicate professionally with requesting providers to obtain additional information and discuss treatment requests as appropriate.
  • Prepare and refer cases that cannot be approved at first-level review to the appropriate Physician Reviewer.
  • Review additional medical information received in connection with reconsiderations.
  • Identify and appropriately process duplicate Requests for Authorization.
  • Maintain accurate and timely documentation of utilization review activity.
  • Ensure required communications and regulatory timeframes are met.
  • Manage multiple reviews, priorities, and deadlines in a fast-paced remote work environment.


Required Qualifications

  • Active, unrestricted California professional license as an LVN, RN, or DC.
  • Must reside and work in California.
  • Clinical experience relevant to your licensed discipline and the clinical services being reviewed. Three or more years of relevant clinical experience is preferred.
  • Strong clinical assessment, critical-thinking, analytical, and problem-solving skills.
  • Excellent written and verbal communication skills.
  • Strong attention to detail, organization, and time-management skills.
  • Ability to work independently and manage multiple priorities and deadlines.
  • Ability to navigate multiple software systems concurrently.
  • Proficiency with Microsoft Office and web-based platforms.
  • Minimum typing speed of 45 WPM.
  • Ability to perform extensive telephone- and computer-based work.


Preferred Qualifications

  • Previous workers' compensation experience.
  • Previous utilization review or utilization management experience.
  • Experience in occupational medicine, orthopedics, neurology, rehabilitation, musculoskeletal care, acute care, case management, occupational health, disability management, or another relevant clinical specialty.
  • Familiarity with MTUS and evidence-based treatment guidelines.
  • Relevant professional certification or advanced credential appropriate to your discipline.


Schedule & Work Environment

  • Full-time
  • Monday-Friday during standard business hours
  • Home-based/remote position
  • Must work from within California
  • Hourly, non-exempt
  • Overtime eligible in accordance with applicable California law


Compensation

$42.00-$45.00 per hour

The compensation range reflects the responsibilities and requirements of the Health Care Professional/First-Level Reviewer position. Actual starting compensation within the range will be based on relevant utilization review and workers' compensation experience, clinical experience, qualifications, certifications, and other job-related factors.


Why Encompass?

This is an opportunity to use your clinical experience in a different way-helping facilitate timely, medically appropriate treatment decisions for injured workers while working in a structured, professional, home-based environment.

At Encompass, we value clinical integrity, accuracy, professionalism, and doing the right thing for our clients, providers, injured workers, and employees.


Equal Employment Opportunity

Encompass Health Solutions is an Equal Opportunity Employer. We are committed to maintaining a workplace free from discrimination and harassment in compliance with applicable federal, state, and local laws. Employment decisions are made without regard to race, color, religion, sex, gender identity, sexual orientation, age, national origin, disability, veteran status, marital status, or any other characteristic protected by law.

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