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Remote Utilization Review Rn Jobs in Santa Rosa, CA

Madrona Hospice Care Inc.

Registered Nurse

Santa Rosa, CA · Remote

$140 - $150/hr

Review OASIS assessments for completeness, appropriateness, and compliance with federal and state ... Monitor visit utilization and flag potential financial risks or underutilization to clinical ...

Madrona Hospice Care Inc.

Registered Nurse

Petaluma, CA · On-site +1

$140 - $150/hr

Review OASIS assessments for completeness, appropriateness, and compliance with federal and state ... Monitor visit utilization and flag potential financial risks or underutilization to clinical ...

Madrona Hospice Care Inc.

Registered Nurse

Petaluma, CA · Remote

$140 - $150/hr

Review OASIS assessments for completeness, appropriateness, and compliance with federal and state ... Monitor visit utilization and flag potential financial risks or underutilization to clinical ...

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Remote Utilization Review Rn information

See Santa Rosa, CA salary details

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$46

$75

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 Santa Rosa, CA is $46.23, according to ZipRecruiter salary data. Most workers in this role earn between $36.54 and $53.08 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 Santa Rosa, CA?

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

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

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

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

Cities near Santa Rosa, 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 Santa Rosa, CA as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 14% Part Time, 5% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $96,155 per year, or $46.2 per hour.

Registered Nurse

Madrona Hospice Care Inc.

Santa Rosa, CA • Remote

$140 - $150/hr

Full-time, Per diem

Re-posted 9 days ago

Job description

At Madrona Hospice Care Inc., we've designed a plan of care that will work for you and your family. We understand the importance in providing you the guidance to make those decisions easier and before a time of crisis. That’s why we have a diverse team of experienced professionals to offer a broad range of services.

As a Registered Nurse with Madrona Hospice Care, you will play a meaningful role in helping patients heal, stay safe, and thrive in the comfort of their own environment.

We value teamwork, empathy, and a commitment to high-quality service, all aimed at putting patients and their families at ease during their transition. If you are passionate about making a positive impact in patients' lives and working in a supportive and family-oriented atmosphere, we encourage you to join us in providing exceptional home hospice care.

Please note that this role is per diem with a rate of $140 - $150 per visit.

Responsibilities
  • Review OASIS assessments for completeness, appropriateness, and compliance with federal and state regulations.
  • Ensure accurate ICD-10 coding and sequencing based on each patient’s medical condition and co-morbidities.
  • Partner with clinical staff to resolve documentation and data integrity issues.
  • Monitor visit utilization and flag potential financial risks or underutilization to clinical management.
  • Identify and communicate trends that impact agency outcomes and process measures.
  • Conduct OASIS inter-rater reliability visits with clinical team members.
  • Participate in Quality Improvement and Corporate Compliance activities.
  • Stay current with best practices through ongoing education and professional development.
  • Perform other duties as required for patient services.

Requirements

  • Active Californian RN license in good standing.
  • 1–2 years of clinical home health experience.
  • Working knowledge of OASIS assessments and ICD-10 coding.
  • Knowledge of federal regulations and state licensure requirements.
  • Strong communication skills and a keen eye for detail.
  • Ability to work independently and manage priorities with minimal supervision.
  • Proficiency with computer systems and electronic health records.
  • Current CPR certification with AHA.
  • Valid driver’s license, reliable insured vehicle.

Nice to Have

  • OASIS certification (COS-C).
  • OASIS Home Health ICD-10 coding certification.

Benefits

  • Flexible Schedule
  • Ability to Convert to Full-Time Based On Performance If Interested
  • Paid Sick Days
  • Paid Bereavement Leave
  • Skills Training & Development
  • Company Social Events
  • Mileage Reimbursement for Patient to Patient Visits
  • Referral Bonus