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Clinical Review Rn Jobs in California (NOW HIRING)

KPC Health

Utilization Review RN

Santa Ana, CA · On-site

Utilization Review RN The Utilization Review RN reviews client health records to ensure proper ... Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and ...

OU Health (Parent)

Utilization Review RN

Whittier, CA · On-site

$2.8K/wk

Details Client Name PIH HEALTH Job Type Travel Offering Nursing Profession Registered Nurse Specialty Utilization Review Job ID 18027156 Job Title Utilization Review RN Weekly Pay $2800.0 Shift ...

KPC Global MSO

Utilization Review RN

Santa Ana, CA · On-site

SUMMARY The Utilization Review RN reviews client health records to ensure proper utilization of ... Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and ...

Prime Staffing

Travel Utilization Review RN

Orange, CA · On-site

Prime Staffing is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Orange, California. & Requirements * Specialty: Utilization Review * Discipline: RN * Start ...

TotalMed RN

Travel Utilization Review RN

Escondido, CA · On-site

TotalMed RN is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job ... clinicians of all specialties in all 50 states. They offer local and travel jobs and match ...

TotalMed RN

Travel Utilization Review RN

Irvine, CA · On-site

TotalMed RN is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job ... clinicians of all specialties in all 50 states. They offer local and travel jobs and match ...

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All JobsClinical Review Rn JobsClinical Review Rn Jobs in California

Clinical Review Rn information

What is a clinical review RN?

Clinical Review RNs, or Clinical Review Registered Nurses, are licensed nurses who evaluate medical records, treatment plans, and health care documentation to ensure that patient care meets established standards and guidelines. They play a critical role in reviewing the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. Clinical Review RNs often work for insurance companies, hospitals, or healthcare organizations to help with utilization management, case review, and quality assurance. Their expertise helps improve patient outcomes and manage healthcare costs by ensuring the right care is delivered at the right time.

What skills and qualifications are needed to thrive as a clinical review RN?

To thrive as a Clinical Review RN, you need a robust clinical nursing background, strong assessment skills, and an active RN license, often with experience in case management or utilization review. Familiarity with utilization management software, electronic health records, and knowledge of insurance regulations or CMS guidelines is typically required. Excellent communication, critical thinking, and attention to detail help set outstanding Clinical Review RNs apart. These skills ensure accurate clinical evaluations, compliance with regulations, and effective coordination between patients, providers, and payers.

How does a clinical review RN collaborate with other healthcare professionals during the patient care review process?

A Clinical Review RN regularly works with physicians, case managers, social workers, and insurance representatives to assess the medical necessity and appropriateness of patient care plans. They participate in interdisciplinary meetings, provide clinical insights, and help ensure that care decisions align with policies and regulations. This collaboration is key to streamlining the review process, minimizing delays in patient care, and supporting optimal outcomes for both patients and the healthcare organization.

What is the difference between Clinical Review Rn vs Medical Reviewer?

AspectClinical Review RnMedical Reviewer
CredentialsRegistered Nurse (RN) license, clinical experienceMedical degree (MD or DO), specialized training
Work EnvironmentHealthcare facilities, insurance companies, telehealthHospitals, insurance companies, consulting firms
Employer & Industry UsageInsurance, healthcare providers, government agenciesInsurance, legal, healthcare consulting
Primary FocusAssessing medical records, determining coverage eligibilityEvaluating medical cases, providing expert opinions

While both roles involve reviewing medical information, Clinical Review Rns primarily assess insurance claims and medical records as registered nurses, whereas Medical Reviewers are typically physicians with advanced medical training who evaluate complex cases and provide expert opinions. Understanding these differences helps in choosing the right career path or job search focus.

How to become a clinical review RN?

To become a clinical review RN, you typically need to earn a Bachelor of Science in Nursing (BSN) or an associate degree in nursing, pass the NCLEX-RN exam to obtain licensure, and gain clinical experience in healthcare settings. Additional certifications in case management or utilization review can enhance qualifications for this role.

What does a clinical review RN do?

A clinical review RN evaluates medical records, treatment plans, and patient data to determine coverage, appropriateness, and compliance with healthcare policies. They often work for insurance companies or healthcare organizations, requiring strong clinical knowledge, attention to detail, and certification such as a registered nurse license. Their assessments help ensure proper patient care and cost-effective treatment decisions.
Clinical Review Rn jobs near you
Infographic showing various Clinical Review Rn job openings in California as of August 2026, with employment types broken down into 17% As Needed, and 83% Full Time. Highlights an 83% In-person, and 17% Remote job distribution.

Travel Utilization Review RN - $1,738 per week

Torrance, CA • On-site

Focus
Recruiting and Staffing Services • 11 - 50 employees
Learn more about Focusexternal

$1.7K/wk

Other

Medical, Retirement

Posted 5 days ago

Job description

Focus Staff is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Torrance, California.

Job Description & Requirements
  • Specialty: Utilization Review
  • Discipline: RN
  • Start Date: 09/21/2026
  • Duration: 13 weeks
  • 40 hours per week
  • Shift: 8 hours, days
  • Employment Type: Travel

We currently have a client in Torrance, CA looking for a Travel Utilization Review RN Registered Nurse!
Focus Staff is seeking a Travel Utilization Review RN Registered Nurse to review and audit behind the scenes to maximize the quality and cost efficiency of health care services.
Candidates need to possess phenomenal efficiency and attention to detail with a strong knowledge of procedures and patient safety. Being Compassionate and sensitive is a prerequisite for the profession. The ideal Candidates goes a step further by being a critical thinker and fast to act with emergencies.
If you are seeking a Utilization Review RN position and would like to work with an agency that will listen to your needs and career goals, then Focus Staff is the right place to be. We are proud of our ability to build relationships with all our healthcare professionals, whether you are seeking Travel assignments, PRN work or Permanent Placed positions.
Contract Assignment - 13 Weeks (Temporary)
Shift: 5x8 Days
Responsibilities:

  • Perform initial, concurrent, discharge, and retrospective reviews on all patients
  • Review current charts for appropriateness and correct admission status
  • Communicate directly with insurance companies and/or payor to obtain admission and continued stay certification or recertification
  • Facilitate peer to peer appeal for concurrent denials
  • Assign a working diagnosis related groups on all patients
  • Communicate with physicians regarding patients who do not meet criteria to identify additional documentation needs or potential status changes
  • Communicate effectively about problems or trends with insurance companies
  • Perform chart analysis on quality surveillance and special studies
  • All other responsibilities as needed
Requirements:
  • Motivated candidates who are looking for career growth
  • AHA Current Basic Life Support certification for Health Care Providers
  • Experience analyzing documentation of clinical care
  • Excellent communication skills with the staff, physicians, patients, and families

Work Experience: At least 2 years of experience
Rewards: (Utilization Review Registered Nurse Benefits)
  • Pay depends on location and experience.
  • We are offering a very competitive package to the right Utilization Review RN candidate.
  • Most traveling healthcare providers enjoy the flexibility and the capability to travel and work in various settings and work environments.
If You have a Passion for Utilization Review, Apply Today and a Recruiter will guide you through the Process.
Job Type: Contract/Temporary/Travel
Join our VIP team of Traveling Professionals!
Utilization RN – Utilization Review RN – Travel Utilization Review RN, Part-Time, Contract, Travel, Temporary, 13 Weeks, Temp. Tier5, Travel Utilization Review RN Registered Nurse

Focus Staff Job ID #a0xVt00000TgL2XIAV. Pay package is based on 8 hour shifts and 40.0 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Travel Utilization Review RN Registered Nurse

About Focus Staff

Your Journey, Our Focus. Travel Confidently, Care Boldly with Focus Staff.

At Focus Staff, we’re here to make your travel healthcare career rewarding, seamless, and stress-free.

Whether you’re a travel nurse, therapist, or allied health professional, we take care of the details so you can focus on what you do best — caring for others. Our mission is simple: to help healthcare heroes like you thrive, no matter where your journey takes you.

With thousands of job opportunities across all 50 states, our dedicated recruiters work closely with you to match you to the right assignment, based on what matters most to you — pay, location, benefits, or career growth.

From day one, you’ll enjoy premium benefits like medical coverage that bridges between assignments, 401K matching, travel and licensing reimbursements, and personalized housing support. Plus, our team is here for you 24/7, with clinical support available whenever you need guidance or backup.

At Focus Staff, we believe in making every assignment a smooth, comfortable, and empowering experience. Let’s make your next adventure your best one yet.

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