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Work From Home Utilization Review Jobs in Riverside, CA

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Work from Home

Santa Ana, CA · Remote

$25/hr

Have a desire to work from home * Looking to earn extra income Requirements * Access to a computer or smartphone * Have high-speed internet access * Follow instructions * Basic reading and writing ...

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Work from Home

Ontario, CA · Remote

$25/hr

Have a desire to work from home * Looking to earn extra income Requirements * Access to a computer or smartphone * Have high-speed internet access * Follow instructions * Basic reading and writing ...

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Work from Home

Santa Ana, CA · Remote

$25/hr

Have a desire to work from home * Looking to earn extra income Requirements * Access to a computer or smartphone * Have high-speed internet access * Follow instructions * Basic reading and writing ...

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Work from Home

Riverside, CA · Remote

$25/hr

Have a desire to work from home * Looking to earn extra income Requirements * Access to a computer or smartphone * Have high-speed internet access * Follow instructions * Basic reading and writing ...

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Work from Home

Santa Ana, CA · Remote

$25/hr

Have a desire to work from home * Looking to earn extra income Requirements * Access to a computer or smartphone * Have high-speed internet access * Follow instructions * Basic reading and writing ...

Earn Haus

Work from Home

Menifee, CA · Remote

$25/hr

Have a desire to work from home * Looking to earn extra income Requirements * Access to a computer or smartphone * Have high-speed internet access * Follow instructions * Basic reading and writing ...

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Work from Home

Hesperia, CA · Remote

$25/hr

Have a desire to work from home * Looking to earn extra income Requirements * Access to a computer or smartphone * Have high-speed internet access * Follow instructions * Basic reading and writing ...

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Work from Home

Rancho Cucamonga, CA · Remote

$25/hr

Have a desire to work from home * Looking to earn extra income Requirements * Access to a computer or smartphone * Have high-speed internet access * Follow instructions * Basic reading and writing ...

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Work from Home

Fontana, CA · Remote

$25/hr

Have a desire to work from home * Looking to earn extra income Requirements * Access to a computer or smartphone * Have high-speed internet access * Follow instructions * Basic reading and writing ...

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Work from Home

Orange, CA · Remote

$25/hr

Have a desire to work from home * Looking to earn extra income Requirements * Access to a computer or smartphone * Have high-speed internet access * Follow instructions * Basic reading and writing ...

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Work from Home

Orange, CA · Remote

$25/hr

Have a desire to work from home * Looking to earn extra income Requirements * Access to a computer or smartphone * Have high-speed internet access * Follow instructions * Basic reading and writing ...

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Work from Home

Grand Terrace, CA · Remote

$25/hr

Have a desire to work from home * Looking to earn extra income Requirements * Access to a computer or smartphone * Have high-speed internet access * Follow instructions * Basic reading and writing ...

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Work from Home

Orange, CA · Remote

$25/hr

Have a desire to work from home * Looking to earn extra income Requirements * Access to a computer or smartphone * Have high-speed internet access * Follow instructions * Basic reading and writing ...

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Work from Home

Highland, CA · Remote

$25/hr

Have a desire to work from home * Looking to earn extra income Requirements * Access to a computer or smartphone * Have high-speed internet access * Follow instructions * Basic reading and writing ...

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Work from Home

San Bernardino, CA · Remote

$25/hr

Have a desire to work from home * Looking to earn extra income Requirements * Access to a computer or smartphone * Have high-speed internet access * Follow instructions * Basic reading and writing ...

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Work From Home Utilization Review information

See Riverside, CA salary details

$16

$33

$55

How much do work from home utilization review jobs pay per hour?

As of May 29, 2026, the average hourly pay for work from home utilization review in Riverside, CA is $33.32, according to ZipRecruiter salary data. Most workers in this role earn between $23.32 and $42.40 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Work From Home Utilization Review Nurse, and why are they important?

To thrive as a Work From Home Utilization Review Nurse, you need a current RN license, strong clinical assessment skills, and a solid understanding of medical necessity criteria. Familiarity with utilization management software, electronic health records (EHRs), and certifications such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ) are often required. Exceptional communication, critical thinking, and time management skills help in effectively coordinating care and interacting with patients and providers remotely. These skills ensure accurate and efficient reviews, compliance with guidelines, and optimal patient outcomes while working independently.

What are some common challenges faced by Work From Home Utilization Review professionals, and how can they be managed?

Work From Home Utilization Review professionals often face challenges such as maintaining effective communication with healthcare providers and team members, managing time efficiently without in-person supervision, and navigating multiple electronic health record systems remotely. To manage these challenges, it’s important to establish clear communication channels, set structured daily routines, and stay updated with technology training. Many organizations offer virtual team meetings and resources to support remote collaboration and continuous professional development.

What is a Work From Home Utilization Review job?

A Work From Home Utilization Review job involves evaluating the necessity, appropriateness, and efficiency of medical services provided to patients, typically for insurance companies or healthcare organizations. Employees in this role review patient records, treatment plans, and medical claims to ensure compliance with established guidelines and standards. Working remotely, these professionals often communicate with healthcare providers, patients, and insurance representatives to gather information and make recommendations regarding coverage or continued care.

What is the difference between Work From Home Utilization Review vs Work From Home Medical Coder?

AspectWork From Home Utilization ReviewWork From Home Medical Coder
CredentialsTypically requires healthcare-related certifications, such as RN, LPN, or medical reviewer credentialsRequires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentRemote, often involves reviewing medical records and insurance claimsRemote, involves reviewing and assigning medical codes to patient records
Industry UsageCommon in insurance, healthcare administration, and utilization managementCommon in medical billing, coding, and healthcare documentation

Work From Home Utilization Review and Work From Home Medical Coder roles both operate remotely within the healthcare industry. While utilization reviewers focus on assessing the necessity of medical services, medical coders assign standardized codes to patient records. Both require healthcare-related certifications and are essential for healthcare administration, but they differ in daily tasks and specific credentials.

What are popular job titles related to Work From Home Utilization Review jobs in Riverside, CA? For Work From Home Utilization Review jobs in Riverside, CA, the most frequently searched job titles are:
What job categories do people searching Work From Home Utilization Review jobs in Riverside, CA look for? The top searched job categories for Work From Home Utilization Review jobs in Riverside, CA are:
What cities near Riverside, CA are hiring for Work From Home Utilization Review jobs? Cities near Riverside, CA with the most Work From Home Utilization Review job openings:
Work From Home Utilization Review jobs near you
Utilization Review Technician III

Utilization Review Technician III

Prime Healthcare

Ontario, CA • On-site, Remote

$23.15 - $30.03/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 11 days ago

Prime Healthcare rating

6.3

Company rating: 6.3 out of 10

Based on 268 frontline employees who took The Breakroom Quiz

660th of 864 rated healthcare providers

Job description

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!
 


The Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. This position will also serve as a liaison and own the coordination with other UR techs in the team while being responsible for coordinating phone calls, data entry, mailing/faxing appeals and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals. Document and track all communication attempts with insurance providers and health plans and scan all related correspondence to the respective EMR/ tracking tool. Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers. The Utilization review tech will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned. UR tech III will also function as an SME to support the UR tech team and remote counter parts with the specific processes as applicable. The Utilization review tech will further support the department needs for Release of Information through faxing and mailing, discharge coordination or other duties as assigned.


  1. Bachelor’s degree or four years of relevant experience required.
  2. Microsoft office proficiency.
  3. Good communication skills

Preferred qualifications:

  1. Completion of a medical terminology course; preferred.
  2. Knowledge of HIPAA regulations preferred.

Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $23.15 to $30.03. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.


Full Time
Days

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

 

Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf

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