Los Angeles, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Los Angeles, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
San Diego, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Bakersfield, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Bakersfield, CA · Remote
$30.37 - $59.21/hr
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred. To all current Molina employees: If you are interested in applying for this position, please ...
Long Beach, CA · Remote
$29.05 - $56.64/hr
Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. Identifies and reports quality of care issues. Assists with complex claim review ...
Long Beach, CA · Remote
$29.05 - $56.64/hr
Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. Identifies and reports quality of care issues. Assists with complex claim review ...
REMOTE (work from home) The Medical Director role provides clinical expertise in assessing the ... review and clinical decision making.
REMOTE (work from home) The Medical Director role provides clinical expertise in assessing the ... review and clinical decision making.
REMOTE (work from home) The Medical Director role provides clinical expertise in assessing the ... review and clinical decision making.
REMOTE (work from home) The Medical Director role provides clinical expertise in assessing the ... review and clinical decision making.
REMOTE (work from home) California Nevada Arizona Oregon Florida The Medical Director role provides ... Conduct medical reviews and make independent clinical decisions of hematology and oncology ...
REMOTE (work from home) California Nevada Arizona Oregon Florida The Medical Director role provides ... Conduct medical reviews and make independent clinical decisions of hematology and oncology ...
Roseville, CA · On-site +1
$59.23 - $81.24/hr
Reviews patient medical records, assessing the appropriateness and necessity of proposed treatments ... Two years' utilization review experience using the Optum/Inter Qual product within the last 12 ...
Roseville, CA · On-site +1
$59.23 - $81.24/hr
Reviews patient medical records, assessing the appropriateness and necessity of proposed treatments ... Two years' utilization review experience using the Optum/Inter Qual product within the last 12 ...
Roseville, CA · On-site +1
$54.68 - $81.95/hr
Reviews patient medical records, assessing the appropriateness and necessity of proposed treatments ... Two years' utilization review experience using the Optum/Inter Qual product within the last 12 ...
Roseville, CA · On-site +1
$54.68 - $81.95/hr
Reviews patient medical records, assessing the appropriateness and necessity of proposed treatments ... Two years' utilization review experience using the Optum/Inter Qual product within the last 12 ...
San Francisco, CA · Remote
$60 - $80/hr
Remote Role Responsibilities * Review and assess clinical documentation for accuracy, completeness ... Experience in CDI, case management, utilization review, or quality improvement. * Exposure to ...
Quick apply
San Francisco, CA · Remote
$60 - $80/hr
Remote Role Responsibilities * Review and assess clinical documentation for accuracy, completeness ... Experience in CDI, case management, utilization review, or quality improvement. * Exposure to ...
Cerritos, CA · Remote
$275K - $325K/yr
REMOTE (work from home) California Nevada Arizona Oregon Florida The Medical Director role provides ... Conduct medical reviews and make independent clinical decisions of hematology and oncology ...
Quick apply
Cerritos, CA · Remote
$275K - $325K/yr
REMOTE (work from home) California Nevada Arizona Oregon Florida The Medical Director role provides ... Conduct medical reviews and make independent clinical decisions of hematology and oncology ...
Rancho Cordova, CA · Remote
$53.46 - $79.52/hr
As a remote employee, we will provide you with the equipment needed to work from home, including a ... Demonstrates a working knowledge of Utilization Management, UM review processes, and regulatory ...
Rancho Cordova, CA · Remote
$53.46 - $79.52/hr
As a remote employee, we will provide you with the equipment needed to work from home, including a ... Demonstrates a working knowledge of Utilization Management, UM review processes, and regulatory ...
Rancho Cordova, CA · Remote
$53.46 - $79.52/hr
As a remote employee, we will provide you with the equipment needed to work from home, including a ... Demonstrates a working knowledge of Utilization Management, UM review processes, and regulatory ...
Rancho Cordova, CA · Remote
$53.46 - $79.52/hr
As a remote employee, we will provide you with the equipment needed to work from home, including a ... Demonstrates a working knowledge of Utilization Management, UM review processes, and regulatory ...
Long Beach, CA · Remote
$26.41 - $51.49/hr
Remote position, must reside in Arizona. Work hours: Monday - Friday 8:30am- 5:00pm Mountain Time ... Adheres to utilization management (UM) policies and procedures. Required Qualifications At least 2 ...
Long Beach, CA · Remote
$26.41 - $51.49/hr
Remote position, must reside in Arizona. Work hours: Monday - Friday 8:30am- 5:00pm Mountain Time ... Adheres to utilization management (UM) policies and procedures. Required Qualifications At least 2 ...
Produce seat utilization reporting and run the monthly utilization review Renewals & Vendor ... Have experience using AI tools to improve personal or team productivity Location This is a remote ...
New
Produce seat utilization reporting and run the monthly utilization review Renewals & Vendor ... Have experience using AI tools to improve personal or team productivity Location This is a remote ...
New
Torrance, CA · Remote
$120K - $130K/yr
Medical
Dental
Vision
Life
Retirement
... remote programming environments. The Director brings strong clinical insight, operational ... Partner with admissions, marketing, business development, and utilization review teams to ensure ...
Torrance, CA · Remote
$120K - $130K/yr
Medical
Dental
Vision
Life
Retirement
... remote programming environments. The Director brings strong clinical insight, operational ... Partner with admissions, marketing, business development, and utilization review teams to ensure ...
Torrance, CA · On-site +1
$120K - $130K/yr
Medical
Dental
Vision
Life
Retirement
... remote programming environments. The Director brings strong clinical insight, operational ... Partner with admissions, marketing, business development, and utilization review teams to ensure ...
Torrance, CA · On-site +1
$120K - $130K/yr
Medical
Dental
Vision
Life
Retirement
... remote programming environments. The Director brings strong clinical insight, operational ... Partner with admissions, marketing, business development, and utilization review teams to ensure ...
Long Beach, CA · Remote
$26.41 - $43/hr
Adheres to utilization management (UM) policies and procedures. Required Qualifications At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
Long Beach, CA · Remote
$26.41 - $43/hr
Adheres to utilization management (UM) policies and procedures. Required Qualifications At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
San Diego, CA · Remote
Retirement
This team is primarily responsible for care and case management and utilization review of behavioral health and substance abuse services, which includes risk assessment, de-escalation and ...
New
San Diego, CA · Remote
Retirement
This team is primarily responsible for care and case management and utilization review of behavioral health and substance abuse services, which includes risk assessment, de-escalation and ...
New
San Diego, CA · Remote
Retirement
This team is primarily responsible for care and case management and utilization review of behavioral health and substance abuse services, which includes risk assessment, de-escalation and ...
New
San Diego, CA · Remote
Retirement
This team is primarily responsible for care and case management and utilization review of behavioral health and substance abuse services, which includes risk assessment, de-escalation and ...
New
$21.11 - $25.38
2% of jobs
$25.38 - $29.65
9% of jobs
$32.58 is the 25th percentile. Wages below this are outliers.
$29.65 - $33.92
21% of jobs
The median wage is $37.38 / hr.
$33.92 - $38.20
23% of jobs
$38.20 - $42.47
13% of jobs
$45.79 is the 75th percentile. Wages above this are outliers.
$42.47 - $46.74
10% of jobs
$46.74 - $51.01
8% of jobs
$51.01 - $55.28
5% of jobs
$55.28 - $59.55
5% of jobs
$59.55 - $63.82
2% of jobs
$63.82 - $68.09
2% of jobs
$21
$41
$68
A Remote Utilization Review job involves assessing medical records and treatment plans to ensure they meet insurance guidelines and medical necessity criteria. Professionals in this role, often nurses or healthcare specialists, work remotely to review patient care for cost-effectiveness and compliance with policies. They collaborate with healthcare providers, insurance companies, and case managers to approve or deny services based on established guidelines. This position requires strong analytical skills, knowledge of medical policies, and attention to detail.
A typical day for a Remote Utilization Review professional involves reviewing patient medical records, evaluating the necessity of proposed treatments against established guidelines, and collaborating with healthcare providers to gather additional information when needed. You will spend much of your time analyzing documentation, submitting recommendations, and ensuring that care authorization decisions align with payer policies and clinical best practices. Communication with case managers, physicians, and insurance representatives is frequent and essential. The work is generally independent and deadline-driven but requires strong teamwork and responsiveness through virtual meetings, emails, and calls.
To thrive as a Remote Utilization Review professional, you need a solid foundation in clinical knowledge, critical thinking, and an active RN or LPN license, often supported by experience in case management or prior authorization. Familiarity with medical coding (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required, along with URAC or related certifications. Excellent communication, attention to detail, and strong organizational skills help you efficiently manage cases and coordinate with providers and payers. These skills ensure accurate assessments of medical necessity, compliance with regulations, and effective remote collaboration with healthcare teams.
The most popular types of Utilization Review jobs in California are:
For Remote Utilization Review jobs in California, the most frequently searched job titles are:
The top searched job categories for Remote Utilization Review jobs in California are:
Cities in California with the most Remote Utilization Review job openings:
Los Angeles, CA • Remote
$30.37 - $59.21/hr
Full-time
Re-posted 5 days ago
8.0
Based on 199 frontline employees who took The Breakroom Quiz
164th of 309 rated insurance
JOB DESCRIPTION Job Summary
Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
• Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.
• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
• Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.
• Processes requests within required timelines.
• Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
• Requests additional information from members or providers as needed.
• Makes appropriate referrals to other clinical programs.
• Collaborates with multidisciplinary teams to promote the Molina care model.
• Adheres to utilization management (UM) policies and procedures.
Required Qualifications
• At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Ability to prioritize and manage multiple deadlines.
• Excellent organizational, problem-solving and critical-thinking skills.
• Strong written and verbal communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
Certified Professional in Healthcare Management (CPHM).
Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred.
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: $30.37 - $59.21 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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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.
Health care and social assistance
10,000+ Employees
Long Beach, CA, US
1980
