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Remote Utilization Review Rn Jobs in Sunnyvale, CA

Madrona Hospice Care Inc.

Registered Nurse

San Jose, 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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All JobsUtilization Review Rn JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in Sunnyvale, CA

Remote Utilization Review Rn information

See Sunnyvale, CA salary details

$25

$49

$80

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

As of Jul 19, 2026, the average hourly pay for remote utilization review rn in Sunnyvale, CA is $49.62, according to ZipRecruiter salary data. Most workers in this role earn between $39.23 and $56.97 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 Sunnyvale, CA? For Remote Utilization Review Rn jobs in Sunnyvale, CA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Sunnyvale, CA look for? The top searched job categories for Remote Utilization Review Rn jobs in Sunnyvale, CA are:
What cities near Sunnyvale, CA are hiring for Remote Utilization Review Rn jobs? Cities near Sunnyvale, 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 Sunnyvale, CA as of July 2026, with employment types broken down into 77% Full Time, 8% Part Time, and 15% Contract. Highlights an 100% Remote job distribution, with an average salary of $103,219 per year, or $49.6 per hour.
Registered Nurse - Clinical Documentation

Registered Nurse - Clinical Documentation

Mercor

San Francisco, CA • Remote

$60 - $80/hr

Full-time

Posted 17 days ago

Job description

About the job

Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst, Peter Thiel, Adam D'Angelo, Larry Summers, and Jack Dorsey.

Position: Registered Nurses (Data labelling and training)
Type: Contract
Compensation: $60–$80/hour
Location: Remote

Role Responsibilities

  • Review and assess clinical documentation for accuracy, completeness, and quality.
  • Analyze healthcare workflows and recommend process improvements.
  • Interpret patient records and clinical notes to support product development.
  • Identify documentation gaps, inconsistencies, and edge cases.
  • Collaborate with product, engineering, and operations teams to refine AI-driven healthcare tools.
  • Ensure adherence to healthcare regulations, policies, and best practices.

Qualifications

Must-Have

  • Active Registered Nurse (RN) license.
  • 3–5+ years of clinical nursing experience.
  • Strong understanding of clinical documentation and healthcare workflows.
  • Experience working with EHR systems (Epic, Cerner, Meditech, etc.).
  • Excellent analytical, communication, and problem-solving skills.

Preferred

  • Experience in CDI, case management, utilization review, or quality improvement.
  • Exposure to healthcare technology, AI tools, or digital health products.
  • Ability to collaborate effectively with cross-functional teams.

Application Process (Takes 20–30 mins to complete)

  • Upload resume
  • AI interview based on your resume
  • Submit form

Resources & Support

  • For details about the interview process and platform information, please check: https://talent.docs.mercor.com/welcome
  • For any help or support, reach out to: support@mercor.com

PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.