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Case Manager Utilization Review Nurse Jobs in Riverside, CA

Medix

Utilization Review Nurse

Orange, CA · On-site

$38 - $53/hr

  • Medical

  • Dental

  • Vision

  • Retirement

Manage the beginning-to-end Utilization Management (UM) process through Discharge Planning ... Provide clear, concise clinical case reports during daily multidisciplinary rounds. Minimum ...

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · Remote

$30.64 - $45.80/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Utilization Review Nurse gathers demographic and clinical information on prospective ... Case Management department and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS ...

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · On-site

$30.64 - $45.80/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Utilization Review Nurse gathers demographic and clinical information on prospective ... Case Management department and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS ...

CorVel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · On-site

$30.64 - $45.80/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Utilization Review Nurse gathers demographic and clinical information on prospective ... Case Management department and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS ...

Prime Healthcare

Utilization Review Technician III

Ontario, CA · On-site

$24.65 - $30.03/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

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 ...

KPC Global MSO

Utilization Review Tech

Santa Ana, CA · On-site

SUMMARY Under direction of the Utilization Review Technician Supervisor, the Utilization Review ... Management Department, and directed in several aspects of duties. Position is non-RN/LVN. ...

KPC Health

Utilization Review Tech

Santa Ana, CA · On-site

Utilization Review Technician Under direction of the Utilization Review Technician Supervisor, the ... Management Department, and directed in several aspects of duties. Position is non-RN/LVN. ...

Prime Healthcare

Utilization Review Technician III

Ontario, CA · On-site +1

$24.65 - $30.03/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

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 ...

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Case Manager Utilization Review Nurse information

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$49

$83

How much do case manager utilization review nurse jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for case manager utilization review nurse in Riverside, CA is $49.59, according to ZipRecruiter salary data. Most workers in this role earn between $36.88 and $59.95 per hour, depending on experience, location, and employer.

What is a case manager utilization review nurse?

A Case Manager Utilization Review Nurse is a registered nurse who evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, coordinate with healthcare providers, and ensure that treatments meet established guidelines and insurance requirements. Their goal is to optimize patient outcomes while controlling healthcare costs and ensuring compliance with regulations. These nurses also help facilitate communication between patients, providers, and payers to support effective care management.

How does a case manager utilization review nurse typically collaborate with physicians and other healthcare providers?

Case Manager Utilization Review Nurses regularly work with physicians, social workers, and other healthcare professionals to ensure patients receive appropriate care while managing resource utilization. They often participate in interdisciplinary team meetings to discuss care plans, review patient progress, and address any barriers to discharge. Building strong communication channels and maintaining up-to-date clinical knowledge are essential, as nurses must advocate for patients while also supporting evidence-based practices and regulatory compliance. This collaborative environment helps streamline patient care and optimize outcomes.

What are the key skills and qualifications needed to thrive as a case manager utilization review nurse, and why are they important?

To excel as a Case Manager Utilization Review Nurse, you need a solid background in nursing, strong clinical assessment skills, and a valid RN license, often with case management certification. Familiarity with utilization review software, electronic health record (EHR) systems, and knowledge of insurance and regulatory guidelines is essential. Exceptional communication, critical thinking, and negotiation abilities set top performers apart in this role. These qualifications ensure effective patient advocacy, cost-effective care, and compliance with healthcare standards.

What is the difference between Case Manager Utilization Review Nurse vs Case Manager?

AspectCase Manager Utilization Review NurseCase Manager
CredentialsRN license, certification in utilization review (e.g., URAC)RN license, case management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community health, insurance providers
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

While both roles involve patient care coordination, the Case Manager Utilization Review Nurse primarily focuses on reviewing medical necessity and insurance approvals, whereas the Case Manager handles broader patient care coordination and discharge planning. Both roles require nursing credentials and are vital in healthcare settings, but their specific responsibilities differ.

What does a case manager utilization review nurse do?

A case manager utilization review nurse evaluates medical cases to determine the necessity, appropriateness, and efficiency of healthcare services. They review patient records, collaborate with healthcare providers, and ensure treatment plans comply with insurance and regulatory guidelines, often using electronic health record systems. This role requires clinical nursing experience and knowledge of healthcare policies.

What are popular job titles related to Case Manager Utilization Review Nurse jobs in Riverside, CA?

For Case Manager Utilization Review Nurse jobs in Riverside, CA, the most frequently searched job titles are:

What job categories do people searching Case Manager Utilization Review Nurse jobs in Riverside, CA look for?

The top searched job categories for Case Manager Utilization Review Nurse jobs in Riverside, CA are:

What cities near Riverside, CA are hiring for Case Manager Utilization Review Nurse jobs?

Cities near Riverside, CA with the most Case Manager Utilization Review Nurse job openings:

Case Manager Utilization Review Nurse jobs near you

Travel RN Case Manager / Utilization Review

American Traveler

Irvine, CA • On-site

Contractor

Medical, Dental, Vision, Life, Retirement

Posted yesterday

New

Job description

American Traveler is seeking a travel nurse RN Case Management for a travel nursing job in Irvine, California.

Job Description & Requirements
  • Specialty: Case Management
  • Discipline: RN
  • Start Date: 09/15/2026
  • Duration: 13 weeks
  • 40 hours per week
  • Shift: 8 hours, days
  • Employment Type: Travel
Assignment Overview
  • Shift: Days, 5x8hrs
  • Hours: 40 hrs/wk
  • Start Date: Sep 15, 2026
  • Length: 13 weeks
  • Openings: 1
Description

American Traveler is hiring an experienced RN Case Manager/Utilization Review nurse for a cancer specialty hospital, requiring a BSN, active CA RN license, and 5 years of relevant experience.

Details
  • Case Management/Utilization Review position at a cancer specialty hospital
  • Day shift schedule, 5x8-hour shifts from 8:00 AM to 4:30 PM
  • Weekend work required
  • Utilizes Epic EMR and InterQual documentation
  • Uses SBAR communication method
Requirements
  • Active CA RN license required in hand, no pending licenses accepted
  • BSN required
  • Current BLS certification required
  • Minimum 5 years of case management/utilization review experience required
  • Acute hospital and Long Term Acute Care/Rehab/Skilled Nursing experience required
  • Experience with InterQual Criteria and Milliman Guidelines required
  • Utilization review experience including admission criteria, appeals and denials, concurrent review, continued stay reviews, medical necessity, and retrospective review
  • Knowledge of CMS, CPT coding, DRG, HEDIS, HIPAA, ICD-10 coding, NCQA, OSHA, and Joint Commission standards
  • Care coordination and discharge planning experience required
  • Epic charting experience required
Additional Information
  • Responsible for care coordination, discharge planning, and utilization review functions
  • Conducts admission criteria reviews, appeals and denials management, and concurrent and retrospective reviews
  • Ensures compliance with regulatory standards including CMS, HIPAA, and Joint Commission requirements
  • Flu vaccine or signed declination form required during flu season (October-March)
  • No restrictive rules on requested time off
  • First-time travelers are welcome to apply
  • Travel pairs are allowed
  • Local candidates accepted within a 75-mile radius at local rate
  • Former employees will not be considered for this position

American Traveler Job ID #P-744779. Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Travel RN - Case Management/Utilization Review - Case Management

About American Traveler

With over 25 years of experience, American Traveler has established a reputation for outstanding customer service. Our team ensures a smooth, worry-free experience for those starting on or expanding their travel nursing and allied careers.

With thousands of travel nursing and allied jobs nationwide, our attentive and approachable recruiters find positions that align perfectly with your career aspirations and personal requirements.

American Traveler offers exceptional benefits, including premium medical, dental, vision and life insurance beginning day one of your assignment, generous 401(k) match, substantial housing stipends, and more. Additionally, with 24/7 support and access to our in-house clinicians, you are assured confidence and comfort throughout your assignment.

With our team behind you, you can relax and enjoy a rewarding travel career.

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