UM Nurse Reviewer
Orange, CA ยท On-site
Utilization Management Authorization Review Nurse Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering ...
Orange, CA ยท On-site
Utilization Management Authorization Review Nurse Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering ...
Orange, CA ยท On-site
Utilization Management Authorization Review Nurse Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering ...
Riverside, CA ยท On-site
$49K - $74K/yr
Responsibilities include providing general counseling, case management, community outreach, and ... the utilization of appropriate community resources, provide education and information to the ...
Riverside, CA ยท On-site
$49K - $74K/yr
Responsibilities include providing general counseling, case management, community outreach, and ... the utilization of appropriate community resources, provide education and information to the ...
Santa Ana, CA ยท On-site
$24.80 - $37.31/hr
SUMMARY Under direction of the Utilization Review Technician Supervisor, the Utilization Review ... in a health plan medical management documentation system a plus * Extremely proficient with ...
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Santa Ana, CA ยท On-site
$24.80 - $37.31/hr
SUMMARY Under direction of the Utilization Review Technician Supervisor, the Utilization Review ... in a health plan medical management documentation system a plus * Extremely proficient with ...
Riverside, CA ยท On-site
$85 - $120/hr
Prepare and analyze clinical data for research purposes, process improvement, utilization ... Two or more years' of behavioral health experience preferred. * Working knowledge in ICD-10-PCS and ...
Riverside, CA ยท On-site
$85 - $120/hr
Prepare and analyze clinical data for research purposes, process improvement, utilization ... Two or more years' of behavioral health experience preferred. * Working knowledge in ICD-10-PCS and ...
Santa Ana, CA ยท On-site
SUMMARY Under direction of the Utilization Review Technician Supervisor, the Utilization Review ... in a health plan medical management documentation system a plus * Extremely proficient with ...
Santa Ana, CA ยท On-site
SUMMARY Under direction of the Utilization Review Technician Supervisor, the Utilization Review ... in a health plan medical management documentation system a plus * Extremely proficient with ...
Montclair, CA ยท On-site
$23/hr
As a member of the Prime Healthcare Foundation, Montclair Hospital Medical Center is actively ... Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and functions ...
Montclair, CA ยท On-site
$23/hr
As a member of the Prime Healthcare Foundation, Montclair Hospital Medical Center is actively ... Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and functions ...
Montclair, CA ยท On-site
$23/hr
As a member of the Prime Healthcare Foundation, Montclair Hospital Medical Center is actively ... Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and functions ...
Montclair, CA ยท On-site
$23/hr
As a member of the Prime Healthcare Foundation, Montclair Hospital Medical Center is actively ... Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and functions ...
Orange, CA ยท On-site
Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members. SUMMARY: The Utilization Management Authorization Review Nurse is responsible for ...
Orange, CA ยท On-site
Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members. SUMMARY: The Utilization Management Authorization Review Nurse is responsible for ...
$35.45 - $37.12/hr
Job Summary The Behavioral Health Care Manager (ACSW) supports CalAMS ECM program for patients with ... Promote engagement and self-management by empowering members to participate in their care. * Model ...
$35.45 - $37.12/hr
Job Summary The Behavioral Health Care Manager (ACSW) supports CalAMS ECM program for patients with ... Promote engagement and self-management by empowering members to participate in their care. * Model ...
Riverside, CA ยท On-site
$49K - $74K/yr
Responsibilities include providing general counseling, case management, community outreach, and ... the utilization of appropriate community resources, provide education and information to the ...
Riverside, CA ยท On-site
$49K - $74K/yr
Responsibilities include providing general counseling, case management, community outreach, and ... the utilization of appropriate community resources, provide education and information to the ...
San Jacinto, CA ยท On-site
$35.45 - $37.12/hr
Job Summary The Behavioral Health Care Manager (ACSW) supports CalAMS ECM program for patients with ... Promote engagement and self-management by empowering members to participate in their care. * Model ...
San Jacinto, CA ยท On-site
$35.45 - $37.12/hr
Job Summary The Behavioral Health Care Manager (ACSW) supports CalAMS ECM program for patients with ... Promote engagement and self-management by empowering members to participate in their care. * Model ...
Redlands, CA ยท On-site
$49.98 - $72.47/hr
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. The Care Manager is accountable for a designated patient caseload and plans effectively ...
Redlands, CA ยท On-site
$49.98 - $72.47/hr
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. The Care Manager is accountable for a designated patient caseload and plans effectively ...
Riverside, CA ยท On-site
$95K/yr
Experience: 1+ years in care management, behavioral health, or related setting (Medi-Cal/ECM preferred) * Bilingual English/Spanish preferred * Strong communication and care coordination skills
Riverside, CA ยท On-site
$95K/yr
Experience: 1+ years in care management, behavioral health, or related setting (Medi-Cal/ECM preferred) * Bilingual English/Spanish preferred * Strong communication and care coordination skills
Riverside, CA ยท On-site
$85K - $120K/yr
Prepare and analyze clinical data for research purposes, process improvement, utilization ... Two or more years' of behavioral health experience preferred. * Working knowledge in ICD-10-PCS and ...
Riverside, CA ยท On-site
$85K - $120K/yr
Prepare and analyze clinical data for research purposes, process improvement, utilization ... Two or more years' of behavioral health experience preferred. * Working knowledge in ICD-10-PCS and ...
Redlands, CA ยท On-site
$49.98 - $72.47/hr
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. The Care Manager is accountable for a designated patient caseload and plans effectively ...
Redlands, CA ยท On-site
$49.98 - $72.47/hr
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. The Care Manager is accountable for a designated patient caseload and plans effectively ...
Redlands, CA ยท On-site
$49.98 - $72.47/hr
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. The Care Manager is accountable for a designated patient caseload and plans effectively ...
Redlands, CA ยท On-site
$49.98 - $72.47/hr
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. The Care Manager is accountable for a designated patient caseload and plans effectively ...
Redlands, CA ยท On-site
$65/hr
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. The Care Manager is accountable for a designated patient caseload and plans effectively ...
Redlands, CA ยท On-site
$65/hr
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. The Care Manager is accountable for a designated patient caseload and plans effectively ...
Corona, CA ยท On-site
$22 - $24/hr
The Behavioral Health Technician collaborates with their team and Behavioral Health Technician ... Demonstrate proper techniques for de-escalation, crisis intervention and behavior management
Corona, CA ยท On-site
$22 - $24/hr
The Behavioral Health Technician collaborates with their team and Behavioral Health Technician ... Demonstrate proper techniques for de-escalation, crisis intervention and behavior management
$22 - $24/hr
The Behavioral Health Technician collaborates with their team and Behavioral Health Technician ... Demonstrate proper techniques for de-escalation, crisis intervention and behavior management
$22 - $24/hr
The Behavioral Health Technician collaborates with their team and Behavioral Health Technician ... Demonstrate proper techniques for de-escalation, crisis intervention and behavior management
Corona, CA ยท On-site
$22 - $24/hr
The Behavioral Health Technician collaborates with their team and Behavioral Health Technician ... Demonstrate proper techniques for de-escalation, crisis intervention and behavior management
Corona, CA ยท On-site
$22 - $24/hr
The Behavioral Health Technician collaborates with their team and Behavioral Health Technician ... Demonstrate proper techniques for de-escalation, crisis intervention and behavior management
$22.32 - $26.83
2% of jobs
$26.83 - $31.35
9% of jobs
$34.44 is the 25th percentile. Wages below this are outliers.
$31.35 - $35.86
21% of jobs
The median wage is $39.52 / hr.
$35.86 - $40.38
23% of jobs
$40.38 - $44.89
13% of jobs
$48.40 is the 75th percentile. Wages above this are outliers.
$44.89 - $49.40
10% of jobs
$49.40 - $53.92
8% of jobs
$53.92 - $58.43
5% of jobs
$58.43 - $62.95
5% of jobs
$62.95 - $67.46
2% of jobs
$67.46 - $71.97
2% of jobs
$22
$44
$71
| Aspect | Behavioral Health Utilization Management | Behavioral Health Case Manager |
|---|---|---|
| Credentials | Licenses (e.g., RN, LCSW), certifications in utilization review | Licenses (e.g., LCSW, LPC), case management certifications |
| Work Environment | Insurance companies, healthcare organizations, utilization review departments | Hospitals, community clinics, outpatient facilities |
| Employer & Industry Usage | Health insurance providers, managed care organizations | Behavioral health agencies, hospitals, outpatient clinics |
Behavioral Health Utilization Management focuses on reviewing and authorizing mental health services to ensure appropriate care and cost management. In contrast, Behavioral Health Case Managers coordinate ongoing patient care, providing support and resources to improve treatment outcomes. Both roles require relevant licenses and certifications but differ in their primary responsibilities and work settings.
For Behavioral Health Utilization Management jobs in Riverside, CA, the most frequently searched job titles are:
The top searched job categories for Behavioral Health Utilization Management jobs in Riverside, CA are:
Cities near Riverside, CA with the most Behavioral Health Utilization Management job openings:

Other
Medical, Dental, Vision, Life, Retirement, PTO
Re-posted 16 days ago
Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.
The Utilization Management Authorization Review Nurse is responsible for managing inpatient & outpatient utilization by conducting thorough reviews of clinical documentation and applying clinical knowledge in accordance with relevant Care Guidelines and CMS regulations. This role ensures that all authorizations, deferrals, and denials are processed efficiently, accurately, and in compliance with company policies and regulatory standards. The nurse also issues timely and accurate denial, deferral, or authorization letters, manages clinical & concurrent review processes, and supports compliance with health plan guidelines.
Essential duties and responsibilities include the following:
Benefits:
Qualification requirements:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, including regular and consistent attendance. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or experience:
Language: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups and customers or employees of the organization.
Mathematics: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form.
EEO/AFFIRMATIVE ACTION STATEMENT: It is the policy of Astiva Health to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information or any other protected characteristic under applicable law. This policy relates to all phases of employment, including but not limited to recruiting, employment, placement, promotion, transfer, demotion, reduction of workforce and termination, rates of pay or other forms of compensation, selection for training, the use of all facilities, and participation in all company sponsored employee activities. Provisions in applicable laws providing for bona fide occupational qualifications, business necessity or age limitations will be adhered to by the organization where appropriate. Please refer to Standard Operating Procedure 100 for more information about the organization's Affirmative Action/EEO statement.
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is frequently required to sit and complete work while on a computer. The employee occasionally is required to stand, walk, use hands to finger, handle or feel, reach with hands and arms, stoop, kneel, crouch or crawl, climb or balance, talk and hear.
While performing the duties of this job, the employee is occasionally required to lift or exert force up to 10 pounds.
Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate.
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Health care and social assistance
51 - 200 Employees
Costa Mesa, CA, US
2019