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Clinical Utilization Review Jobs in Riverside, CA

Medix

SNF Review Nurse (LVN or RN)

Orange, CA · On-site

$38 - $51/hr

Remote Utilization Management Nurse - RN/LVN Location: 100% Remote Schedule: Monday-Friday, 8:00 AM ... Utilize MCG criteria to complete clinical reviews and determine medical necessity. * Write clear ...

Alto Pharmacy

Pharmacist [PRN]- Fuze Rx

Irvine, CA · On-site

$66/hr

Clinical Utilization Review and Dispensing Services You'll provide comprehensive and accurate clinical utilization review and dispensing services. This includes: * Review content and accuracy of drug ...

Discovery Behavioral Health

Clinical Director

Orange, CA · On-site

$100K - $120K/yr

The Clinical Director works in a dynamic multidisciplinary team providing treatment services ... Completes utilization reviews, oversees primary therapist process of utilization review and assists ...

Astiva Health, Inc

UM Nurse Reviewer

Orange, CA · On-site

The Utilization Management Authorization Review Nurse is responsible for managing inpatient & outpatient utilization by conducting thorough reviews of clinical documentation and applying clinical ...

GQR

RN - Case Manager

Orange, CA · On-site

$2.0K - $2.1K/wk

... Utilization Review Shift: Day Shift Details: null Day Job Type: Travel *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on ...

UCI Medical Center

RN - Case Manager

Orange, CA · On-site

Minimum of 1 year in utilization review License: Valid state nursing license required ... Experience in clinical review and medical necessity determination. * CPI Blue Card from the Crisis ...

GQR Global Markets

RN - Case Manager

Orange, CA · On-site

$2.0K - $2.1K/wk

... Utilization Review Shift: Day Shift Details: null Day Job Type: Travel *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on ...

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Showing results 21-40

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 Sep 11, 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 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 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 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 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 September 2026, with employment types broken down into 50% Full Time, and 50% Contract. Highlights an 50% In-person, and 50% Remote job distribution, with an average salary of $91,752 per year, or $44.1 per hour.

Registered Nurse - Utilization Review @ UC Irvine Medical Center

Orange, CA • On-site

UCI Medical Center
See more jobs at UCI Medical Centerexternal

$2.7K/wk

Other

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Details
Client Name
UCI Medical Center
Job Type
Travel
Offering
Nursing
Profession
RN
Specialty
Case Manager
Job ID
35554335
Job Title
Registered Nurse - Utilization Review @ UC Irvine Medical Center
Weekly Pay
$2736.0
Shift Details
Shift
Day - 8x5 - 09AM
Scheduled Hours
40
Job Order Details
Start Date
09/21/2026
End Date
12/21/2026
Duration
13 Week(s)
Job Description
Job Title: Registered Nurse
Profession: Nursing
Specialty: Utilization Review
Duration: 13 weeks
Shift: Day
Hours per Shift: 8 hours
Experience: Minimum of 1 year in utilization review
License: Valid state nursing license required
Certifications: All required certifications must be in-hand when applying.
Must-Have:
- Proficiency in EPIC and InterQual.
- Experience in clinical review and medical necessity determination.
- CPI Blue Card from the Crisis Prevention Institute required for all emergency room nurses.
Description:
Candidates must be highly proficient in EPIC and InterQual.
Demonstrated experience using both systems for clinical review and medical necessity determination is required.
This position is in person with the possibility to be remote, Monday through Friday, with no weekends or holidays.
Pre-approved time off is allowed but cannot exceed five days.
Shift times can start between 8 or 9 AM, depending on candidate availability.
All required certifications must be in hand when applying.
Previous charge experience and community hospital experience are preferred.
Experience with acute hospital admission criteria, continued stay reviews, and medical necessity is required.
References from two supervisors are required when applying.
Local candidates will be considered.
Candidates must be prepared for the possibility of no interview with the manager.
Epic experience must be noted in the candidate's work history.
Client Details
Address
101 The City Dr S
City
Orange
State
CA
Zip Code
92868
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