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Clinical Utilization Review Jobs in Riverside, CA

Astiva Health

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 ...

Socket.dev

Case Manager FT Days

Santa Ana, CA · On-site

$94K - $119K/yr

Utilization Management * Conducts medical necessity review for appropriate utilization of services from admission through discharge. * Promotes effective and efficient utilization of clinical ...

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ScionHealth

Case Manager FT Days

Santa Ana, CA · On-site

$94K - $119K/yr

Utilization Management * Conducts medical necessity review for appropriate utilization of services from admission through discharge. * Promotes effective and efficient utilization of clinical ...

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Showing results 41-60

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.

COORDINATOR, INPATIENT ADMISSIONS

Pomona, CA • On-site

Pomona Valley Hospital Medical Center
Health Care and Social Assistance • 1 - 5K employees
Learn more about Pomona Valley Hospital Medical Centerexternal

$24.26 - $34.14/hr

Part-time

Re-posted 26 days ago

Pomona Valley Hospital Medical Center rating

9.2

Company rating: 9.2 out of 10

Based on 26 frontline employees who took The Breakroom Quiz

Job description

Position Summary:The Inpatient Admissions Coordinator is responsible for coordinating the inpatient admission process by verifying insurance eligibility and securing insurance authorizations (including the IPA/Medical Group/PPG), following post stabilization and or inpatient notification processes for all inpatient admissions, inpatient transfers, and observation admissions. Ensuring regulatory and payer compliance standards are met while securing timely inpatient admissions. Working with minimal supervision, the Inpatient Admissions Coordinator manages moderate to complex cases, communicates directly with payers, clinical teams, and case management, ensuring all information is documented accurately within the financial system. This position requires a strong understanding of payer policies, utilization review workflows, admission criteria, and hospital revenue cycle principles. The Inpatient Admissions Coordinator also serves asa resource and mentor to Patient Access team members for questions related to authorizations, workflows, and payer requirements. May perform other duties as assigned.
Required Qualifications: High school diploma or equivalent. Three years' experience in patient access, hospital admissions, utilization review, or insurance authorization. Strong communication, critical thinking, and problem-solving skills. Ability to work independently and manage time-sensitive authorization tasks.
Preferred Qualifications: Cerner/Soarian Financials or similar EMR experience; familiarity with hospital revenue cycle processes.
Salary range: $24.26 - $34.14 hourly. Salary will be commensurate with experience.
As part of our ongoing effort to remain an employer of choice, eligible employees who work qualifying weekend shifts receive a competitive weekend rate.

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About Pomona Valley Hospital Medical Center

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PVHMC is a nationally recognized and accredited 412-bed, not-for-profit community medical center, proudly serving residents in eastern Los Angeles and western San Bernardino counties. With four Centers of Excellence – The Robert and Beverly Lewis Family Cancer Care Center, Stead Heart and Vascular Center, Women and Children’s Center and Trauma Center – PVHMC offers residents specialized services close to home.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Pomona, CA, US

Year founded

1903

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