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Clinical Utilization Review Jobs in Riverside, CA

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · Remote

$30.64 - $45.80/hr

The Utilization Review Nurse gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and out-patient treatment, certifies the medical necessity ...

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · On-site

$30.64 - $45.80/hr

The Utilization Review Nurse gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and out-patient treatment, certifies the medical necessity ...

Acadia Healthcare

Utilization Specialist PRN

Riverside, CA · On-site

$31 - $50/hr

Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... clinical staff. * Conduct reviews, in accordance with certification requirements, of insurance ...

Pacific Grove

Utilization Specialist PRN

Riverside, CA · On-site

$31 - $50/hr

Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... clinical staff. * Conduct reviews, in accordance with certification requirements, of insurance ...

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All JobsClinical Utilization Review JobsClinical Utilization Review Jobs in Riverside, CA

Clinical Utilization Review information

See Riverside, CA salary details

$22

$44

$71

How much do clinical utilization review jobs pay per hour?

As of Jun 15, 2026, the average hourly pay for clinical utilization review in Riverside, CA is $44.11, according to ZipRecruiter salary data. Most workers in this role earn between $34.86 and $50.67 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Clinical Utilization Review specialist, and why are they important?

To thrive as a Clinical Utilization Review specialist, you need a strong background in nursing or healthcare, knowledge of medical terminology, and often an RN or relevant clinical license. Familiarity with utilization management software, healthcare regulations, and medical coding systems such as ICD-10 and CPT is typically required. Analytical thinking, attention to detail, and strong communication skills help professionals collaborate with care teams and explain decisions clearly. These competencies ensure effective review of medical necessity, regulatory compliance, and optimized patient care outcomes.

What are some common challenges faced by Clinical Utilization Review professionals, and how can they be addressed?

Clinical Utilization Review professionals often face challenges such as balancing the need for cost-effective care with ensuring patients receive appropriate services, managing tight deadlines, and navigating complex insurance requirements. Effective communication with healthcare providers and payers is crucial, as is staying up-to-date with regulatory guidelines. Developing strong organizational skills and maintaining a collaborative approach with interdisciplinary teams can help address these challenges and support successful case outcomes.

What jobs pay $10,000 a month without a degree?

Clinical Utilization Review roles typically require a healthcare background and relevant certifications, and they may pay around $10,000 or more per month for experienced professionals. However, most high-paying jobs without a degree in other fields include sales, real estate, entrepreneurship, or skilled trades like plumbing or electrical work, which depend on experience, skills, and market demand.

What is clinical utilization review?

Clinical utilization review is a process in healthcare that evaluates the necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities. Utilization review professionals assess patient records and treatment plans to ensure that care provided is medically necessary and aligns with established guidelines. This process helps control healthcare costs, improves quality of care, and ensures compliance with insurance or regulatory requirements. Utilization review can be done prospectively, concurrently, or retrospectively, depending on the stage of patient care.

What is the most stress-free job that pays well?

Clinical Utilization Review is generally considered a low-stress healthcare role that offers competitive pay, especially for those with strong analytical skills and relevant certifications. The job typically involves reviewing medical cases and insurance claims, often with regular hours and minimal patient interaction, contributing to a less stressful environment compared to other healthcare positions.

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

AspectClinical Utilization ReviewMedical Reviewer
CredentialsRN, LPN, or other healthcare professionals with clinical licensesLicensed physicians, often MDs or DOs
Work EnvironmentInsurance companies, healthcare organizations, or third-party review firmsHospitals, insurance companies, or healthcare organizations
Primary FocusAssessing medical necessity and appropriateness of careProviding expert medical opinions and final review decisions
Common UsageInvolved in reviewing cases for insurance authorizationMaking clinical determinations on coverage and treatment

While both roles involve reviewing medical cases, Clinical Utilization Review professionals focus on evaluating the necessity of care based on clinical guidelines, often working within insurance or healthcare organizations. Medical Reviewers, typically licensed physicians, provide expert medical opinions and make final coverage decisions. Both roles require healthcare credentials and aim to ensure appropriate patient care and cost management, but their scope and responsibilities differ slightly.

What does a utilization review clinician do?

A utilization review clinician evaluates medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They review cases to ensure compliance with insurance policies and clinical guidelines, often using specialized software, and may work closely with healthcare providers and insurance companies to facilitate appropriate patient care. Certification in case management or utilization review is often required.

What jobs pay 2000 a day?

Clinical Utilization Review roles typically do not pay $2,000 per day; such high daily rates are more common in specialized consulting, executive-level positions, or freelance roles in industries like finance, law, or technology. Highly experienced consultants or contractors with niche expertise may command daily rates approaching or exceeding this amount, especially if working independently or on short-term projects. Certifications, extensive experience, and a strong professional reputation are often required for these high-paying opportunities.
What are popular job titles related to Clinical Utilization Review jobs in Riverside, CA? For Clinical Utilization Review jobs in Riverside, CA, the most frequently searched job titles are:
What job categories do people searching Clinical Utilization Review jobs in Riverside, CA look for? The top searched job categories for Clinical Utilization Review jobs in Riverside, CA are:
What cities near Riverside, CA are hiring for Clinical Utilization Review jobs? Cities near Riverside, CA with the most Clinical Utilization Review job openings:
Clinical Utilization Review jobs near you
Infographic showing various Clinical Utilization Review job openings in Riverside, CA as of June 2026, with employment types broken down into 83% Full Time, and 17% Part Time. Highlights an 83% In-person, and 17% Remote job distribution, with an average salary of $91,752 per year, or $44.1 per hour.
Utilization Review Coordinator

Utilization Review Coordinator

Prime Healthcare Management Inc

Ontario, CA • On-site, Remote

$30 - $40.50/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 6 days ago

Prime Healthcare rating

6.3

Company rating: 6.3 out of 10

Based on 270 frontline employees who took The Breakroom Quiz

666th of 872 rated healthcare providers

Job description

Overview

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!

Responsibilities

The Utilization Review Coordinator (URC) essentially functions as a Subject Matter Expert (SME) with regards to coordinating the UR and appeals process as part of the denial management initiatives for all payors. This position will function along with the Medical Review Coordinators (MRCs) responsible for clinical processes and the UR techs responsible for all clerical processes within the front-end UR and denial management processes. The URC is responsible for ensuring the accounts will be processed in a timely and accurate manner for both authorization follow-up and appeals, thereby contributing to appropriate data tracking maneuvers. The URC will also participate in creating and implementing appropriate training material and agenda for new employees. This position will develop metrics and provide an analytical approach to help interpret and implement solutions inferred from trends observed from the available data. Additionally, this position entails working closely with the Corporate/Facility/Remote UR/CM teams, Business Office, Case Managers, Physicians and Administration. The URC will serve as the representative of the UR team with respect to all clerical functions including but not limited to the authorization follow up, documentation, and denial management for Traditional Medicare/ Medicaid as well as Managed care/ commercial payors. With an understanding of the scope of services for the department, the URC will assist the department leadership in accomplishing the set goals for the UR team. Other duties as assigned.

Qualifications

Required Qualifications:

  • Bachelor's degree in Healthcare related field (including Health Information Management and Pharmacy)
  • Microsoft Office proficiency.
  • Strong communication skills.

    • Preferred Qualifications:

  • Completion of a medical terminology course.
  • Knowledge of HIPAA regulations.
  • Excellent written and verbal communication skills. Excellent critical thinking skills.
  • Excellent interpersonal skills to build effective partnering relationships with physicians, nurse staff, coding staff and hospital management staff.
  • Ability to work independently in a time-oriented environment.
  • Computer data entry with 10-key preferred, with accurate typing speed of 35 wpm preferred.
    • Pay Transparency

    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. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $30.00 to $40.50. 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.

    Employment StatusFull TimeShiftDaysEqual Employment Opportunity

    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

    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

    Employment Type: FULL_TIME

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