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Insurance Utilization Review Jobs in Modesto, CA

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How much do insurance utilization review jobs pay per hour?

As of Aug 10, 2026, the average hourly pay for insurance utilization review in Modesto, CA is $44.61, according to ZipRecruiter salary data. Most workers in this role earn between $35.24 and $51.25 per hour, depending on experience, location, and employer.

What are the most common challenges faced by insurance utilization review professionals?

One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.

What are the key skills and qualifications needed to thrive in insurance utilization review?

To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.

What is an insurance utilization review?

An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.

What are popular job titles related to Insurance Utilization Review jobs in Modesto, CA? For Insurance Utilization Review jobs in Modesto, CA, the most frequently searched job titles are:
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What cities near Modesto, CA are hiring for Insurance Utilization Review jobs? Cities near Modesto, CA with the most Insurance Utilization Review job openings:
Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Modesto, CA as of July 2026, with employment types broken down into 1% As Needed, 72% Full Time, 23% Part Time, 1% Temporary, and 3% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $92,784 per year, or $44.6 per hour.

Physician - Pediatrics for Primary Care Clinic

Community Health Centers of America

Livingston, CA • On-site

$280K - $300K/yr

Other

Medical, Dental, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Job description

Description

Community Health Centers of America is hiring for an MD/DO Pediatrician to work in our family practice clinics in Livingston, CA. Willing to supervise NP/PAs. You will be responsible for diagnosing and treating patients in the clinic setting.


Community Health Centers of America is a premier multi-specialty group focused on improving the health of the community through excellence in clinical care. Our goal is to provide better care to the patient with a collaborative, supportive, respectful, and productive work environment for its healthcare professionals.


Sign-On Bonus!


Job Description:

  • Helps patients by evaluating medical conditions.
  • Develops and implements treatment plans, including prescriptions.
  • Monitors and evaluates treatment results.
  • Evaluates patients by interviewing patient, family, and other persons; conducting physical examinations; observing behaviors; reviewing medical history and related documents; selecting, administering, and ordering laboratory tests and evaluating results.
  • Develops treatment plans by determining nature and extent of medical conditions.
  • Maintains interdisciplinary treatment by reviewing treatment plans and progress, and consulting and collaborating with primary care physicians, mental health therapists, nurses, and other health care providers.
  • Assures quality and safe service for patients and staff by enforcing policies, procedures, standards, rules, Joint Commission for Accreditation of Health Care Organizations requirements, and legal regulations; participating in utilization reviews; and remaining available for emergency consultations.
  • Maintains historical records by documenting symptoms, medications, and treatment events and writing summaries.
  • Updates job knowledge by participating in continuing medical educational opportunities, reading professional publications, maintaining personal networks, and participating in professional organizations.
  • Enhances department and organization reputation by accepting ownership for accomplishing new and different requests and exploring opportunities to add value to job accomplishments.

Job Qualifications:

  • Completion of residency
  • Valid state medical license as MD or DO
  • Valid DEA certificate
  • 3 years' experience working as a Physician
  • Current BLS and/or ACLS

SKILLS

  • Excellent verbal and written communication
  • Critical thinking
  • Active listening
  • Social perceptiveness

Our healthcare professionals enjoy competitive benefits, including:

  • Highly competitive salaries with benefits, a 401(k) plan, and CME allowance
  • Sign-On Bonus!
  • Manageable work schedules, providers are not required to work evenings or weekends
  • Some flexibility with schedules - great for providers with families/other responsibilities
  • Night/Weekend call coverage!
  • Opportunity to work with a diverse range of professionals
  • A professionally challenging environment with a mix of disease acuity
  • A career with administrative freedom - appropriate support staff is supplied
  • Access to charting system that has been designed for quick and easy billing. Dictation available (including, but not limited to Dragon).

We are looking for skilled, self-motivated, and enthusiastic Providers. If you are interested, please submit your resume.


Job Types: Full-time, Part-time


Salary: $280,000.00 - $300,000.00 per year, depending on experience


Benefits:

  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Employee assistance program
  • Flexible schedule
  • Health insurance
  • Life insurance
  • Loan forgiveness
  • Malpractice insurance
  • Paid time off
  • Professional development assistance
  • Referral program
  • Relocation assistance
  • Visa sponsorship
  • Vision insurance

License/Certification:

  • California MD/DO license (Required)

Work Location: In person


Schedule:

  • Day shift
  • Monday to Friday
  • No nights
  • No weekends


Requirements

POSITION REQUIREMENTS:

  • Must possess a degree in medicine and a valid license from the California Medical Board.
  • Experience: 3-5 years of related experience preferred; or equivalent combination of education and experience
  • Licenses/Certifications: Appropriate certifications and/or licensures
  • Current BLS/ACLS required
  • Current DEA required
  • In depth knowledge of legal medical guidelines and medicine best practices

SKILLS:

  • Excellent verbal and written communication
  • Active listening and active learning
  • Flexibility to work with a variety of people, differing in ages, personalities, and backgrounds
  • Time management skills to be able to see a high number of patients
  • Interpersonal skills, compassion, and empathy to build positive relationships with patients and colleagues
  • Critical thinking
  • Social perceptiveness
  • Complex problem solving
  • Respect patient confidentiality

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