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Lvn Utilization Review Jobs in Riverside, CA (NOW HIRING)

Prime Healthcare

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

... review of the medical record for the medical necessity, intensity of service and severity of ... Nurse license. * Minimum 3 years RN Utilization Manager working for a Health Plan. * At least 3 ...

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Lvn Utilization Review information

See Riverside, CA salary details

$17

$33

$50

How much do lvn utilization review jobs pay per hour?

As of Sep 11, 2026, the average hourly pay for lvn utilization review in Riverside, CA is $33.23, according to ZipRecruiter salary data. Most workers in this role earn between $27.60 and $37.12 per hour, depending on experience, location, and employer.

What is an LVN Utilization Review?

LVN Utilization Review nurses are Licensed Vocational Nurses who specialize in evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, coordinate with healthcare providers, and help ensure that treatments meet established guidelines and insurance requirements. By assessing the quality and cost-effectiveness of care, they play a vital role in managing healthcare resources and supporting patient advocacy.

What are the key skills and qualifications needed to thrive as an LVN Utilization Review nurse?

To thrive as an LVN Utilization Review nurse, you need a strong clinical background, current LVN licensure, and knowledge of medical terminology and care standards. Familiarity with utilization management software, electronic health records (EHRs), and insurance guidelines is typically required. Strong analytical skills, attention to detail, and effective communication are vital soft skills for collaborating with healthcare teams and ensuring accurate reviews. These skills ensure that patient care is both appropriate and cost-effective while maintaining compliance with regulatory and payer requirements.

What are some common challenges faced by LVNs in Utilization Review positions, and how can they be managed?

LVNs in Utilization Review often encounter challenges such as balancing clinical knowledge with administrative tasks, adapting to evolving insurance guidelines, and managing high caseloads. Navigating frequent policy updates and documentation requirements can be demanding, but staying organized and proactively communicating with healthcare teams helps maintain efficiency. Utilizing available training resources and collaborating closely with RNs, physicians, and insurance representatives can also ease the transition and support professional growth in the role.

What is the difference between Lvn Utilization Review vs Lvn Case Manager?

AspectLvn Utilization ReviewLvn Case Manager
CertificationsLicensed Vocational Nurse (LVN)Licensed Vocational Nurse (LVN)
Work EnvironmentReviewing medical records, insurance, and treatment plans in office or hospital settingsCoordinating patient care, communicating with providers and families, often in clinical or home settings
Employer & IndustryInsurance companies, healthcare facilities, utilization review organizations

While both roles require LVN licensure, Lvn Utilization Review focuses on evaluating medical necessity and reviewing records, whereas Lvn Case Managers actively coordinate patient care and support treatment plans. The roles differ mainly in daily responsibilities but share similar credentials and work environments.

What are popular job titles related to Lvn Utilization Review jobs in Riverside, CA?

For Lvn Utilization Review jobs in Riverside, CA, the most frequently searched job titles are:

What job categories do people searching Lvn Utilization Review jobs in Riverside, CA look for?

The top searched job categories for Lvn Utilization Review jobs in Riverside, CA are:

What cities near Riverside, CA are hiring for Lvn Utilization Review jobs?

Cities near Riverside, CA with the most Lvn Utilization Review job openings:

Lvn Utilization Review jobs near you
Infographic showing various Lvn Utilization Review job openings in Riverside, CA as of September 2026, with employment types broken down into 65% Full Time, 15% Part Time, and 20% Contract. Highlights an 91% In-person, and 9% Remote job distribution, with an average salary of $69,109 per year, or $33.2 per hour.

Utilization Review RN

Ontario, CA • On-site

Prime Healthcare
Hospitals • 10K+ employees
Learn more about Prime Healthcareexternal

$71K - $104K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 13 days ago

Prime Healthcare rating

6.4

Company rating: 6.4 out of 10

Based on 289 frontline employees who took The Breakroom Quiz

Job description

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!


Responsible for the quality and resource management of all authorizations and referrals with the Prime Healthcare Employee EPO. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive review of the medical record for the medical necessity, intensity of service and severity of illness.


EDUCATION, EXPERIENCE, TRAINING

Required qualifications:

  1. Minimum 7 years Post Graduate of an accredited school of nursing and a current state Registered Nurse license.
  2. Minimum 3 years RN Utilization Manager working for a Health Plan.
  3. At least 3 years of experience in utilization review, referrals, authorizations, denials and appeals.
  4. Current BCLS (AHA) certificate upon hire and maintain current.
  5. Knowledge of MCG Criteria and/or InterQual Criteria required.
  6. Experience and knowledge in basic to intermediate computer skills.

Preferred qualifications:

  1. Five years acute care nursing experience preferred.
  2. Experience with self-funded health plan preferred.

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.  Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary.  A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $71,760.00 to $104,000.00 on an annualized basis. 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.


Full Time
Days

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 for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf

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