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Remote Utilization Review Jobs in Riverside, CA (NOW HIRING)

PSC Biotech

Global Software Sales Manager

Pomona, CA · Remote

$140K - $160K/yr

This is a remote position. PSC Software, a division of PSC Biotech, is a leading provider of ... Conduct regular one-on-one coaching sessions, performance reviews, and career development ...

Cotality

Software Development Engineer (Java)

Irvine, CA · On-site +1

$55.50 - $76.25/hr

We are seeking a talented and driven hybrid-remote Professional Software Engineer to join our ... Participate in Code Reviews: Actively conduct and participate in thorough peer code reviews to ...

HMC Architects

BIM Manager

Ontario, CA · On-site +1

This position is eligible for hybrid (office/remote) working arrangement and flexible working hours ... Perform regular model audits and lead quality control reviews in collaboration with project teams

3 Day Blinds

Salesforce Business Partner

Irvine, CA · Remote

$96K - $115K/yr

Review current business processes and salesforce utilization to ensure maximum impact. * Liaise ... Remote #LI-KG1 By submitting your application below, you are providing your prior consent to ...

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All JobsUtilization Review JobsRemote Utilization Review JobsRemote Utilization Review Jobs in Riverside, CA

Remote Utilization Review information

See Riverside, CA salary details

$22

$44

$71

How much do remote utilization review jobs pay per hour?

As of Jul 14, 2026, the average hourly pay for remote utilization review in Riverside, CA is $44.11, according to ZipRecruiter salary data. Most workers in this role earn between $34.86 and $50.67 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Remote Utilization Review position, and why are they important?

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.

What does a typical day look like for someone in a Remote Utilization Review role?

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.

What is a Remote Utilization Review job?

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.

What are the most commonly searched types of Utilization Review jobs in Riverside, CA? The most popular types of Utilization Review jobs in Riverside, CA are:
What are popular job titles related to Remote Utilization Review jobs in Riverside, CA? For Remote Utilization Review jobs in Riverside, CA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review jobs in Riverside, CA look for? The top searched job categories for Remote Utilization Review jobs in Riverside, CA are:
What cities near Riverside, CA are hiring for Remote Utilization Review jobs? Cities near Riverside, CA with the most Remote Utilization Review job openings:
Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Riverside, CA as of July 2026, with employment types broken down into 93% Full Time, and 7% Contract. Highlights an 100% Remote job distribution, with an average salary of $91,752 per year, or $44.1 per hour.
Remote Case Management RN - California License

Remote Case Management RN - California License

Vivo HealthStaff

San Bernardino, CA • On-site, Remote

$43 - $48/hr

Contractor

Re-posted 28 days ago

Job description

Vivo HealthStaff is actively recruiting for a fully remote Case Manager position. This temporary 3-month contract role, with an option to extend, and focuses on health care management and coordination for members with complex and chronic care needs. Utilizing the nursing process, the Case Manager will interact effectively with members, caregivers, and interdisciplinary team participants, all while working remotely.
Job Description:
- Care Coordination: Serve as a remote resource for the member, their family, and their physician, ensuring access to appropriate care and facilitating referrals/authorizations.
- Comprehensive Assessments: Conduct thorough remote assessments, evaluating the member's health status, resource utilization, and treatment plans.
- Care Plan Implementation: Collaborate remotely with the member, PCP, and care team to implement a care plan, interfacing with various healthcare professionals.
- Education and Support: Provide remote education and self-management support tailored to the member's unique learning style.
- Problem Solving: Assist in resolving issues with providers, claims, or services from a remote setting.
- Care Coordination Efficiency: Work closely with delegated or contracted providers to ensure effective care coordination, remotely.
- Compliance: Maintain confidentiality of all PHI in compliance with state and federal law and company policy, while working remotely.
Supervisory Responsibilities:
- None.
Minimum Requirements:
Experience:
- 1-3 years of clinical experience, with 2 or more years in case management.
- Health Plan experience preferred.
Education/Licensure:
- Active, valid, and unrestricted California RN license.
Other Skills:
- Understanding of community resources, treatment options, home health, funding options, and special programs.
- Extensive knowledge of chronic condition management.
- Bilingual in Spanish preferred.
- Excellent verbal and written communication skills.
- Team player with effective relationship-building skills.
- Ability to work independently in a remote setting.
- Experience using standardized clinical guidelines.
- Strong organizational skills.
- Proficiency in PC-based software programs, including Word, Excel, and PowerPoint.
Vivo HealthStaff is a healthcare staffing and recruitment firm based in the San Francisco Bay Area, providing permanent and temporary opportunities to organizations across the United States.
Vivo HealthStaff logo

About Vivo HealthStaff

Sourced by ZipRecruiter

Vivo HealthStaff provides permanent recruitment services for both clinical and administrative positions in the healthcare sector. Over the past 2 years, our clients have seen a 98% retention rate with Vivo HealthStaff placements.

Industry

Health care and social assistance

Company size

11 - 50 Employees

Headquarters location

Dublin, CA, US

Year founded

2016

Social media

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