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Clinical Review Coordinator Jobs in Riverside, CA

Oso Home Care

Intake Coordinator - Full-Time

Irvine, CA · On-site

$26 - $33/hr

The Intake Coordinator serves as the primary point of contact for new patient referrals and is ... Review referrals for completeness and identify missing clinical or demographic information. * Enter ...

Oso Home Care

Intake Coordinator - Full-Time

Irvine, CA · On-site

$26 - $33/hr

The Intake Coordinator serves as the primary point of contact for new patient referrals and is ... Review referrals for completeness and identify missing clinical or demographic information. * Enter ...

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Clinical Review Coordinator information

See Riverside, CA salary details

$11

$29

$48

How much do clinical review coordinator jobs pay per hour?

As of Sep 6, 2026, the average hourly pay for clinical review coordinator in Riverside, CA is $29.89, according to ZipRecruiter salary data. Most workers in this role earn between $21.59 and $35.62 per hour, depending on experience, location, and employer.

What is a clinical review coordinator?

A Clinical Review Coordinator is responsible for reviewing medical records, insurance claims, and treatment plans to ensure they meet regulatory and organizational guidelines. They collaborate with healthcare providers, insurance companies, and patients to verify coverage, process authorizations, and support quality care. The role requires attention to detail, knowledge of medical terminology, and familiarity with healthcare policies.

What are the typical daily responsibilities of a clinical review coordinator?

As a Clinical Review Coordinator, your daily responsibilities often include reviewing patient medical records, assessing the necessity and appropriateness of clinical services, and preparing documentation for insurance or compliance reviews. You may also interact with healthcare providers to clarify clinical information, coordinate with case managers or insurance representatives, and ensure timely processing of authorizations. While most of the work is completed independently, you will frequently collaborate with other healthcare professionals to resolve complex cases. This role offers a balance of analytical tasks and teamwork, providing variety and ongoing professional engagement.

What are the key skills and qualifications needed to thrive in the clinical review coordinator position, and why are they important?

A Clinical Review Coordinator needs a strong background in healthcare, medical terminology, and case management, usually supported by a degree in a health-related field or equivalent experience. Familiarity with electronic health record (EHR) systems, utilization review software, and knowledge of regulatory guidelines like HIPAA is typically required. Attention to detail, excellent organizational skills, and effective communication abilities set successful candidates apart. These competencies enable Coordinators to ensure accurate clinical documentation, streamline review processes, and facilitate collaboration between medical teams and insurance providers.

What are popular job titles related to Clinical Review Coordinator jobs in Riverside, CA?

For Clinical Review Coordinator jobs in Riverside, CA, the most frequently searched job titles are:

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The top searched job categories for Clinical Review Coordinator jobs in Riverside, CA are:

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Clinical Review Coordinator jobs near you

Clinical Review Nurse - Prior Authorization

Akido

Chino, CA • On-site

Full-time

Re-posted 9 days ago

Job description

The Opportunity

  • The Clinical Review Nurse - Prior Authorization & Case Management is responsible for reviewing and processing prior authorization requests to ensure medical necessity, appropriate level of care, and compliance with health plan and regulatory requirements, as well as supporting complex case management for members with ongoing or high-risk care needs. This role is primarily focused on prior authorization review, with secondary responsibility for complex case management as the program grows within the Utilization Management (UM) department, and it supports delegated UM operations in a California managed care environment. The Clinical Review Nurse works closely with providers, Medical Directors, and operational teams to ensure timely and accurate authorization determinations in accordance with established clinical guidelines and delegation standards.

What you'll do

  • Review and process prior authorizations for outpatient services, procedures, diagnostic testing, specialty referrals, and DME and ancillary services
  • Evaluate requests using MCG guidelines and health plan criteria and policies
  • Review medical records and supporting clinical documentation to ensure completeness, accuracy, and medical necessity in accordance with established clinical guidelines and health plan requirements
  • Identify missing or insufficient documentation and coordinate with providers for additional information
  • Support case management for members with complex or high-risk care needs, including care coordination and follow-up
  • Ensure all clinical determinations are properly documented in the system
  • Maintain compliance with DMHC prior authorization requirements, CMS guidelines, health plan delegation standards, turnaround times, notification requirements, and documentation standards
  • Communicate with physicians, medical groups, facilities, and ancillary providers to obtain additional clinical information and provide authorization status updates as needed
  • Identify cases requiring clinical review and prepare clinical summaries for Medical Director determination
  • Ensure cases requiring denial are routed appropriately to the Medical Director
  • Document all authorization activities accurately within EZCap, maintaining detailed notes, status updates, and decision rationale
  • Collaborate with UM Coordinators, Claims, Eligibility, and Operations
  • Conduct comprehensive assessments and contribute to development of patient-centered care plans in collaboration with Medical Director
  • Perform monthly care management outreach, medication review, and specialist/community resource coordination, documenting time and activities

Who you are

  • Active California RN license (required)
  • 3-5+ years of current clinical UM review
  • Experience with prior authorization in managed care or delegated environment
  • Experience with complex case management
  • Knowledge of MCG criteria, medical necessity review, and prior authorization workflows
  • Experience with EZCap (preferred)
  • Experience in a delegated MSO or health plan environment (preferred)
  • Certified Case Manager (CCM) preferred
  • Knowledge of California managed care regulations (DMHC/CMS)
  • Strong clinical assessment skills and attention to detail
  • Effective written and verbal communication
  • Ability to manage competing priorities in a fast-paced environment

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