Utilization Review Nurse LVN
$71K - $99K/yr
Possess an active CA Licensed Vocational Nurse (LVN) license ... Minimum (2) two years of experience in acute hospital case management or equivalent. * Utilization ...
Utilization Review Nurse LVN
$71K - $99K/yr
Possess an active CA Licensed Vocational Nurse (LVN) license ... Minimum (2) two years of experience in acute hospital case management or equivalent. * Utilization ...
The Manager collaborates with physicians, nursing leadership, ancillary departments, post-acute ... The Manager serves as a key leader in interdisciplinary care coordination, utilization review ...
The Manager collaborates with physicians, nursing leadership, ancillary departments, post-acute ... The Manager serves as a key leader in interdisciplinary care coordination, utilization review ...
The Manager collaborates with physicians, nursing leadership, ancillary departments, post-acute ... The Manager serves as a key leader in interdisciplinary care coordination, utilization review ...
The Manager collaborates with physicians, nursing leadership, ancillary departments, post-acute ... The Manager serves as a key leader in interdisciplinary care coordination, utilization review ...
Case Manager*
Loma Linda, CA · On-site
Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred. Knowledge ...
Case Manager*
Loma Linda, CA · On-site
Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred. Knowledge ...
Case Manager*
Loma Linda, CA · On-site
$68.03 - $91.49/hr
Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred. Knowledge ...
Case Manager*
Loma Linda, CA · On-site
$68.03 - $91.49/hr
Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred. Knowledge ...
Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred. Knowledge ...
Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred. Knowledge ...
The Clinical Review Nurse - Prior Authorization & Case Management is responsible for reviewing and ... case management as the program grows within the Utilization Management (UM) department, and it ...
The Clinical Review Nurse - Prior Authorization & Case Management is responsible for reviewing and ... case management as the program grows within the Utilization Management (UM) department, and it ...
Travel RN Case Manager - $2,772 per week
Orange, CA · On-site
$2.7K/wk
Strong assessment, discharge planning, and utilization review skills Description: The RN Case Manager coordinates patient care plans and services across the continuum of care. Works closely with ...
New
Travel RN Case Manager - $2,772 per week
Orange, CA · On-site
$2.7K/wk
Strong assessment, discharge planning, and utilization review skills Description: The RN Case Manager coordinates patient care plans and services across the continuum of care. Works closely with ...
New
Case Manager
$20.50 - $26.50/hr
Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred. Knowledge ...
Case Manager
$20.50 - $26.50/hr
Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred. Knowledge ...
Case Manager
Loma Linda, CA · On-site
$20.50 - $26.50/hr
Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred. Knowledge ...
Case Manager
Loma Linda, CA · On-site
$20.50 - $26.50/hr
Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred. Knowledge ...
Travel Case Manager RN
Irvine, CA · On-site
Key Words: RN Travel, Travel Nurse, Contract Nurse, Agency Nurse, Travel Contract, Travel Nursing, Case Manager, Case Management, Utilization Review, Case Manager RN *Weekly payment estimates are ...
New
Travel Case Manager RN
Irvine, CA · On-site
Key Words: RN Travel, Travel Nurse, Contract Nurse, Agency Nurse, Travel Contract, Travel Nursing, Case Manager, Case Management, Utilization Review, Case Manager RN *Weekly payment estimates are ...
New
Case Manager
Loma Linda, CA · On-site
$59.18 - $79.60/hr
Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred. Knowledge ...
Case Manager
Loma Linda, CA · On-site
$59.18 - $79.60/hr
Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred. Knowledge ...
Case Manager
Loma Linda, CA · On-site
$59.18 - $79.60/hr
Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred. Knowledge ...
Case Manager
Loma Linda, CA · On-site
$59.18 - $79.60/hr
Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred. Knowledge ...
Case Manager
$20.50 - $26.50/hr
Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred. Knowledge ...
Case Manager
$20.50 - $26.50/hr
Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred. Knowledge ...
Case Manager
Loma Linda, CA · On-site
$20.50 - $26.50/hr
Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred. Knowledge ...
Case Manager
Loma Linda, CA · On-site
$20.50 - $26.50/hr
Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred. Knowledge ...
ED Case Manager Utilization RN, PD Midshift
Moreno Valley, CA · On-site
$70 - $90/hr
Reviews, monitors, evaluates and coordinates the patient's hospital stay to assure that all ... Conducts daily clinical reviews for utilization/quality management activities based on guidelines ...
New
ED Case Manager Utilization RN, PD Midshift
Moreno Valley, CA · On-site
$70 - $90/hr
Reviews, monitors, evaluates and coordinates the patient's hospital stay to assure that all ... Conducts daily clinical reviews for utilization/quality management activities based on guidelines ...
New
RN Case Manager
Orange, CA · On-site
Referral bonus up to $700 Registered Nurse (RN),Case Management/Utilization Review, About the Company: Uniti Med is an award-winning healthcare staffing company with a mission to provide staffing ...
New
RN Case Manager
Orange, CA · On-site
Referral bonus up to $700 Registered Nurse (RN),Case Management/Utilization Review, About the Company: Uniti Med is an award-winning healthcare staffing company with a mission to provide staffing ...
New
Local Contract TRA Manager of Case Management The Manager of Case Management & Social Services is ... utilization review, discharge planning, and payer requirements. - Experience leading both Case ...
Local Contract TRA Manager of Case Management The Manager of Case Management & Social Services is ... utilization review, discharge planning, and payer requirements. - Experience leading both Case ...
... Complex Care Case Manager, RN for Workers Compensation managed care team. PRIMARY PURPOSE: The ... Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance ...
... Complex Care Case Manager, RN for Workers Compensation managed care team. PRIMARY PURPOSE: The ... Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance ...
... Case Manager, RN for Workers Compensation managed care team. PRIMARY PURPOSE: The complex care ... Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance ...
... Case Manager, RN for Workers Compensation managed care team. PRIMARY PURPOSE: The complex care ... Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance ...
Case Manager Utilization Review Nurse information
See Riverside, CA salary details
$20.06 - $25.83
3% of jobs
$25.83 - $31.60
6% of jobs
$36.83 is the 25th percentile. Wages below this are outliers.
$31.60 - $37.37
17% of jobs
$37.37 - $43.14
20% of jobs
The median wage is $44.29 / hr.
$43.14 - $48.90
16% of jobs
$48.90 - $54.67
11% of jobs
$55.91 is the 75th percentile. Wages above this are outliers.
$54.67 - $60.44
7% of jobs
$60.44 - $66.21
6% of jobs
$66.21 - $71.98
5% of jobs
$71.98 - $77.74
4% of jobs
$77.74 - $83.51
3% of jobs
$20
$49
$83
How much do case manager utilization review nurse jobs pay per hour?
As of Aug 23, 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?
| Aspect | Case Manager Utilization Review Nurse | Case Manager |
|---|---|---|
| Credentials | RN license, certification in utilization review (e.g., URAC) | RN license, case management certification (e.g., CCM) |
| Work Environment | Hospitals, insurance companies, healthcare facilities | Hospitals, community health, insurance providers |
| Primary Focus | Reviewing medical necessity and appropriateness of care | Coordinating 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 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:
$71K - $99K/yr
Full-time
Medical, Dental, Vision, Retirement, PTO
Re-posted 3 days ago
Prime Healthcare rating
6.4
Based on 286 frontline employees who took The Breakroom Quiz
646th of 893 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!
Responsible for the daily coordination and oversight to the Referral Technicians with regard to referral distribution and tracking. Assists Director of UR Dept. in providing oversight and monitoring productivity of UR Coordinators and Referral Technicians. Provides training to new staff on system and referral processes. Assists physician offices and vendors with problem resolution. Knowledgeable in policies, procedures and practices and keeps updated with regulations applicable to the department including applicable regulations pertinent to Self-Funded Plan.
Education and Work Experience
Required qualifications:
- Possess an active CA Licensed Vocational Nurse (LVN) license.
- Minimum (2) two years of experience in acute hospital case management or equivalent.
- Utilization Management experience required.
- Excellent interpersonal relationship skills with exceptional professional work ethics.
- Extensive knowledge of professional and hospital claims.
- Extensive knowledge of coding, billing.
- High School Diploma or GED
Preferred qualifications:
- Experience and knowledge of Self-Funded plans, HMO plans, ERISA, and HIPAA guidelines.
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. Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $71,760.00 to $99,590.00 on an annualized basis. 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
What Prime Healthcare employees say
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Benefits
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About Prime Healthcare
Sourced by ZipRecruiter
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Ontario, CA, US