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Remote Utilization Review Jobs in Santa Rosa, CA

Alignment Health

Internal Medicine Physician

Novato, CA · Remote

MUST HAVE CALIFORNIA LICENSE Utilization Management Experience The Utilization Management, Medical ... Through remote access to our web-based Portal, physician advisors will complete clinical reviews ...

DataAnnotation

RN

Santa Rosa, CA · Remote

$40 - $60/hr

Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and setting your own schedule. We are looking for an existing Medical Expert (this is an independent ...

DataAnnotation

Registered Nurse

Santa Rosa, CA · Remote

$40 - $60/hr

Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and setting your own schedule. We are looking for an existing Medical Expert (this is an independent ...

All JobsUtilization Review JobsRemote Utilization Review JobsRemote Utilization Review Jobs in Santa Rosa, CA

Remote Utilization Review information

See Santa Rosa, CA salary details

$23

$46

$75

How much do remote utilization review jobs pay per hour?

As of Jun 12, 2026, the average hourly pay for remote utilization review in Santa Rosa, CA is $46.23, according to ZipRecruiter salary data. Most workers in this role earn between $36.54 and $53.08 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 Santa Rosa, CA? The most popular types of Utilization Review jobs in Santa Rosa, CA are:
What are popular job titles related to Remote Utilization Review jobs in Santa Rosa, CA? For Remote Utilization Review jobs in Santa Rosa, CA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review jobs in Santa Rosa, CA look for? The top searched job categories for Remote Utilization Review jobs in Santa Rosa, CA are:
What cities near Santa Rosa, CA are hiring for Remote Utilization Review jobs? Cities near Santa Rosa, CA with the most Remote Utilization Review job openings:
Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Santa Rosa, CA as of June 2026, with employment types broken down into 77% Full Time, 11% Part Time, and 12% Contract. Highlights an 100% Remote job distribution, with an average salary of $96,155 per year, or $46.2 per hour.
Family Practice - Geriatrics Physician

Family Practice - Geriatrics Physician

Alignment Health

Novato, CA • Remote

Full-time

Posted 13 days ago

Job description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

MUST HAVE CALIFORNIA LICENSE
Utilization Management Experience
The Utilization Management, Medical Director works with Senior Medical Officers, Regional Medical Officers, Extensivists, the Healthcare Services Team (Case managers, Social Workers, Utilization Managers) to develop and implement methods to optimize use of Institutional and Outpatient services for all patients while also ensuring the quality of care provided. Through remote access to our web-based Portal, physician advisors will complete clinical reviews for medical necessity, treatment appropriateness and compliance.

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