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

At Pair Team, we're an innovative, mission-driven company reimagining how Medicaid and Medicare serves the most underserved populations. As a tech-enabled medical group, we deliver whole-person care - clinical, behavioral, and social - by partnering with organizations deeply connected to the communities we serve.

We're building a care model that empowers clinicians and care teams to do what they do best: provide compassionate, high-impact care. At Pair Team, we leverage AI and automation to reduce administrative burden, streamline coordination, and ensure patients receive timely, personalized support.

Our work is powered by a deeply collaborative team of nurses, social workers, community health workers, and medical professionals working alongside product, technology, and operations to close care gaps and improve outcomes for high-need patients.

We're one of the largest Enhanced Care Management providers in California and are on track to build the nation's largest clinically integrated network supporting high-need patients. Our model has demonstrated real impact, including a 58% reduction in emergency department visits and a 29% reduction in hospital admissions.

At Pair Team, were not just delivering care - we're building the future of more equitable, community-driven healthcare.

Our Values

• Lead with integrity: We keep our commitments and take responsibility for our actions. We are dependable and choose authenticity over perfection.
• Embrace challenges: We leave our egos at the door and step forward into discomfort instead of back into safety. We help each other to learn and provide feedback using candor and kindness.
• Break through walls: We go the extra mile for our patients, partners and one another, and we run toward hard things. We are resilient in our push for consistent improvement and challenge the status quo.
• Act beyond yourself: We build each other up and respect boundaries. We seek first to understand and assume positive intent.
• Care comes first: We hold ourselves to the highest standards for our patients. We are relentless in the pursuit of our mission, and ensure that we are taking care of ourselves in order to care for others.

• Forbes: For Pair Team, Accessibility Is About Delivering Healthcare To Those Who Need It The Most
• TechCrunch: Building for Medicaid's regulatory moment with Neil Batlivala from Pair Team
• Axios: Pair Team collects $9M for Medicaid-based care

Pair Team is building a team of deeply passionate individuals ready to change primary care operations for those who need it most. We are looking for a highly motivated full-time Healthcare Call Center Representative who is willing to think creatively and empathically to help our team change the way people access healthcare.

We seek a full-time Healthcare Call Center Representative to play a critical role in our whole-person, interdisciplinary care model, responsible for directly outreaching and engaging with individuals living with Serious Mental Illness/ Substance Use Disorder, experiencing homelessness, and/or those who have high medical needs. We believe in the power of trust and relationships to successfully engage those who may have never received the kind of whole-health care that Pair Team can provide.
Please note: internally, this role is referred to as a Lead Care Manager. While the position is 90% remote within the United States, candidates must be able to work Pacific Time business hours on a consistent basis and be based in California. This role supports a fast-paced, high-volume care environment, so comfort working within a structured schedule aligned to PST is important for success.

• Maintain ongoing caseload of individuals through the utilization of evidence based approaches to promote engagement and achievement of health goals
• Use relationship-based strategies to support members with social support navigation, understanding that many may have lived personal experiences causing them to be initially hesitant or distrusting of the health care system
• Conducts periodic telephonic and SMS outreach to ensure timely follow-up to members
• Work with members to identify health/wellness goals and incorporate goals into Health Action Plan/Shared Care Plan
• Supports nurse care manager, behavioral health care manager, nurse practitioner and Community Engagement Specialist with delegated tasks
• Collaborates on care issues with Enhanced Care Management team by participating in systematic case reviews and consulting with nurse care manager, behavioral health care manager, and nurse practitioner before taking clinical actions
• Consistently meet monthly encounter metrics to ensure compliance with health plan regulations
• Identify and break down barriers ensuring individuals' continuation with the program
• Assists individuals in securing connection to community supports by scheduling appointments, managing referrals, and ensuring timely follow-ups
• Coordinate physical care management appointments through collaboration with external and internal providers
• Utilize external and internal online platforms to collaborate with team members and carry out daily tasks

• 1+ years of professional experience, preferably in case management, care coordination, or healthcare call center setting
• Bilingual in English and Spanish
• Strong understanding of cultural fluency and the ability to build trust with diverse populations
• High degree of empathy and ability to remain patient when faced with adversity
• Demonstrated ability to work collaboratively in a multidisciplinary care team
• Excellent organizational skills and attention to detail
• Strong technical skills and comfort learning new systems; experience with tools such as Google Suite, Slack, CRM databases, and basic Excel, Word, email, and video conferencing
• Reliable, HIPAA-compliant workspace with a stable internet connection for documentation and team communication
  

• Salary: $25/hour
• Comprehensive health, vision & dental insurance
• 401k
• Monthly $100 work from home expense stipend for your WFH days
• Flexible vacation policy -- take the time you need to recharge!
• We provide all of the equipment needed for the role
• Opportunity for rapid career progression with plenty of room for personal growth!