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

Fortive

Account Manager

Irvine, CA · On-site +1

Drive market share through existing customer utilization assessments and contending for new ... Routinely update sales actions plans and forecasts for Territory Quarterly Reviews and Business ...

Fortive

Account Manager - Raleigh

Irvine, CA · Remote

Drive market share through existing customer utilization assessments and contending for new ... Routinely update sales actions plans and forecasts for Territory Quarterly Reviews and Business ...

Fortive

Account Manager

Irvine, CA · Remote

Drive market share through existing customer utilization assessments and contending for new ... Routinely update sales actions plans and forecasts for Territory Quarterly Reviews and Business ...

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

LIBERTY DENTAL

System Configuration Analyst

Tustin, CA · On-site +1

Are you energized by solving complex Utilization Management (UM) and claims scenarios while ... Primarily remote, office-based work * Role involves extensive computer use, data review, and system ...

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

DataAnnotation

Registered Nurse

Santa Ana, CA · Remote

$40 - $60/hr

Join the DataAnnotation team and contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and setting your own schedule. We are looking for a Medical Expert ...

DataAnnotation

Registered Nurse

Ontario, CA · Remote

$40 - $60/hr

Join the DataAnnotation team and contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and setting your own schedule. We are looking for a Medical Expert ...

DataAnnotation

RN

Fontana, CA · Remote

$40 - $60/hr

Join the DataAnnotation team and contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and setting your own schedule. We are looking for a Medical Expert ...

DataAnnotation

RN

Jurupa Valley, CA · Remote

$40 - $60/hr

Join the DataAnnotation team and contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and setting your own schedule. We are looking for a Medical Expert ...

DataAnnotation

Registered Nurse

Fontana, CA · Remote

$40 - $60/hr

Join the DataAnnotation team and contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and setting your own schedule. We are looking for a Medical Expert ...

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All 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 May 30, 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 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 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.
More about Remote Utilization Review jobs
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 May 2026, with employment types broken down into 88% Full Time, 6% Part Time, and 6% Contract. Highlights an 100% Remote job distribution, with an average salary of $91,752 per year, or $44.1 per hour.
Bilingual Case Manager (Remote Flexible, Spanish Speaking)

Bilingual Case Manager (Remote Flexible, Spanish Speaking)

Pair Team

San Bernardino, CA • On-site, Remote

$22 - $28/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 7 days ago

Job description

About Pair Team
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.
In the News
  • 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
About the Opportunity
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 Lead Care Manager who is willing to think creatively and empathically to help our team change the way people access healthcare.
We seek a full-time Lead Care Manager 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.
This position primarily allows for remote work; however, it includes 2-3 times a month on-site visits in the community alongside a fellow PairMate. You can expect to engage in these in-person activities 2-3 times per month, close to your city, while the majority of your duties, approximately 90%, will be performed from your home
What You'll Do
  • 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 member 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

What You'll Need
  • 1+ years of general work experience (Case Management preferred)
  • You are physically located in California
    • Field Ops requires you to maintain reliable transportation for engagement at clinic, community based organization, and health system partner locations
    • Virtual Ops requires a quiet, HIPAA compliant and internet connected space
  • Bilingual - English/Spanish
  • Strong understanding of cultural fluency
  • High degree of empathy
  • Ability to work collaboratively in a multidisciplinary team
  • An eye for optimization
  • Organizational skills
  • Ability to remain patient when faced with adversity
  • Strong technical skills and comfort with technology innovation, past experience with CRM databases, basic Excel, Word, email, and video conferencing
  • A valid driver's license and auto liability insurance
Preferred Qualifications:
  • Demonstrated professional or personal lived experience working closely with individuals experiencing complex chronic needs, homelessness, or Severe Mental Illness/Substance Use Disorder
  • 2+ years of case management experience
  • Experience with motivational interviewing
  • Knowledge of medical terminology
  • Zest for problem solving, seeking answers, and thinking outside the box
  • Detail-oriented and organized self-starter who is a rockstar multitasker
  • Reliable and comfortable in an ever-changing environment

Because We Value You
  • Salary: $22-$25/hour
  • Comprehensive health, vision & dental insurance
  • 401k
  • Monthly $100 work from home expense stipend for your WFH days
  • Gas reimbursements for your on-site engagement 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!

Pair Team is an Equal Opportunity Employer. At Pair Team, we value diversity and strive to provide an inclusive environment for all applicants and employees. All applicants will be considered without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, marital status, age, disability, political affiliation, military service, genetic information, or any other characteristic covered by federal, state, or local law.
Pair Team participates in E-Verify to verify employment eligibility for new hires.
Any offer of employment at Pair Team is conditioned upon passing a pre-employment background check. Following a conditional job offer, candidates will undergo comprehensive employment background checks, including; criminal history, reference checks, and driving records if a role requires vehicle use.
We do not conduct any TA business outside of our @pairteam.com emails. If you're ever concerned about spam or fraudulent activity, please reach out to recruiting@pairteam.com.
Note: Please be aware that while we sincerely appreciate your interest, due to the high volume of requests, we're unable to respond to general position inquiries via email. To apply for a position with us, please submit your application for the role you are interested in. Our team regularly reviews applications and will reach out to candidates whose qualifications align with our current openings listed below. Thank you!

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