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Case Manager Utilization Review Nurse Jobs in Riverside, CA

Medix

Utilization Review Nurse

Orange, CA · On-site

$38 - $53/hr

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

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. ...

New

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. ...

New

Prime Healthcare

Utilization Review RN

Ontario, CA

$71K - $104K/yr

Responsible for the quality and resource management of all authorizations and referrals with the ... Minimum 3 years RN Utilization Manager working for a Health Plan. * At least 3 years of experience ...

Prime Healthcare

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

Responsibilities Responsible for the quality and resource management of all authorizations and ... Minimum 3 years RN Utilization Manager working for a Health Plan. * At least 3 years of experience ...

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Case Manager Utilization Review Nurse information

See Riverside, CA salary details

$20

$49

$83

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

As of Aug 7, 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 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.

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 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.

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 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

Utilization Review Nurse

Medix

Orange, CA • On-site

$38 - $53/hr

Full-time

Medical, Dental, Vision, Retirement

Posted 28 days ago

Job description

You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.
Job Summary
Our client is seeking a Utilization Review Nurse responsible for managing the complete Utilization Management (UM) process, from admission through discharge planning. The primary goal is to conduct daily inpatient reviews, concurrent reviews, discharge planning, and coordinating care for DME, Home Health, and Skilled Nursing Facility (SNF) placements.
Responsibilities / Job Duties
  • Manage the beginning-to-end Utilization Management (UM) process through Discharge Planning.
  • Conduct daily inpatient review, concurrent review, discharge planning, and coordinate care for DME, Home Health, and SNF placements.
  • Utilize MCG criteria for clinical reviews and write formal denial letters.
  • Apply LCD/NCD to pre-service authorizations when determining appropriate clinical tiers.
  • Communicate confidently and effectively with Medical Directors, physicians, and hospital counterparts.
  • Provide clear, concise clinical case reports during daily multidisciplinary rounds.

Minimum Education and Experience Qualification Requirements
Qualifications
  • Active and unencumbered California RN or LVN License.
  • Strongly prefer 5+ years of concurrent Inpatient UM experience.
  • Direct experience working within an IPA, MSO, Delegation model, or Health Plan setting.
  • Proven, hands-on experience navigating and applying MCG criteria for inpatient acute/SNF reviews.
  • Experience in handling complex discharge planning, writing denial letters, and applying Medicare guidelines for SNF and ARU.
  • Proficiency with standard digital workspace tools (Microsoft Excel, Word, and PDFs).

Skills
  • Proficiency with MCG criteria and guidelines.
  • Effective communication with medical staff and hospital counterparts.
  • Technical skills with software tools such as Microsoft Excel, Word, and PDFs.

Schedule / Shift
Standard Shift: 8:00 AM - 5:00 PM PST, Monday through Friday, including a 1-hour lunch break, a morning break, and an afternoon break.
Benefits
  • Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
  • Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
  • 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
  • Short Term Disability Insurance.
  • Term Life Insurance Plan.

* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
Medix Overview:
With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we're dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.
* As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient's residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
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About Medix Staffing Solutions

Sourced by ZipRecruiter

Since 2001, we’ve been dedicated to helping you achieve your goals. Medix was created to become a leading provider of workforce solutions for clients and candidates across the healthcare and life sciences industries. Today, we are that leader. Headquartered in Chicago, we have 23 offices across the United States, and staff talent around the world. Medix is committed to fulfilling our core purpose as an organization: to positively impact the lives of our talent, clients, and teammates through employment, philanthropy, and opportunity. The combination of purpose and values has nurtured our thriving culture that encourages our internal team to excel at work and in everyday life.

Industry

Recruiting and staffing services

Company size

1,001 - 5,000 Employees

Headquarters location

Chicago, IL, US

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