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Manager Utilization Management Jobs in California

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Manager Utilization Management information

See California salary details

$38.5K

$89.8K

$165.3K

How much do manager utilization management jobs pay per year?

As of Aug 21, 2026, the average yearly pay for manager utilization management in California is $89,819.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,700.00 and $108,100.00 per year, depending on experience, location, and employer.

What does a manager utilization management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.

What are the key skills and qualifications needed to thrive as a manager utilization management?

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

What are some common challenges faced by a manager utilization management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

What is the difference between Manager Utilization Management vs Utilization Review Nurse?

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

What are the most commonly searched types of Utilization Management jobs in California?

The most popular types of Utilization Management jobs in California are:

What are popular job titles related to Manager Utilization Management jobs in California?

For Manager Utilization Management jobs in California, the most frequently searched job titles are:

What job categories do people searching Manager Utilization Management jobs in California look for?

The top searched job categories for Manager Utilization Management jobs in California are:

What cities in California are hiring for Manager Utilization Management jobs?

Cities in California with the most Manager Utilization Management job openings:

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in California as of August 2026, with employment types broken down into 91% Full Time, 2% Part Time, and 7% Contract. Highlights an 94% In-person, 2% Hybrid, and 4% Remote job distribution, with an average salary of $89,819 per year, or $43.2 per hour.

Registered Nurse- Utilization Management

HJ Staffing

Long Beach, CA • On-site

Full-time

Posted 27 days ago

Job description

We are seeking a Registered Nurse (RN) to join our Utilization Management team. In this role, you will perform concurrent reviews, prior authorizations, medical necessity reviews, discharge planning, and transitions of care. You will collaborate closely with physicians, hospitals, and interdisciplinary teams to ensure members receive appropriate, cost-effective, and evidence-based care.

This position is ideal for an RN with a strong acute care background and proven experience in managed care and utilization management.

Key Responsibilities
  • Utilization Reviews: Perform concurrent, prior authorization, and retrospective utilization reviews.
  • Guideline Application: Evaluate medical necessity using InterQual, MCG, CMS, and LCD/NCD guidelines.
  • Care Coordination: Coordinate discharge planning and seamless transitions of care with providers and healthcare facilities.
  • Interdisciplinary Collaboration: Work alongside physicians, hospital staff, specialists, and internal care management teams.
  • Documentation & Escalation: Request and review additional clinical documentation as needed; escalate complex medical necessity cases to the Medical Director.
  • Provider Education: Educate providers on utilization management policies and review criteria.
  • Compliance & Quality: Accurately document all reviews and decisions within medical management systems while identifying care gaps and supporting quality improvement initiatives.
Required Qualifications
  • Licensure: Active Registered Nurse (RN) license (ability to obtain multi-state licensure if needed).
  • Education: Graduate of an accredited School of Nursing.
  • Clinical Experience: Minimum 4 years of clinical nursing experience.
  • Managed Care Experience: Minimum 2 years of managed care or HMO experience (Medicare Advantage experience required).
  • Core Expertise: Must have direct experience in:
    • Concurrent Review & Inpatient Utilization Management
    • Discharge Planning & Transitions of Care
    • Utilizing InterQual, MCG, and CMS Guidelines
  • Technical Skills: Proficiency with medical management software and Microsoft Office Suite.
  • Soft Skills: Strong critical thinking, excellent communication, and exceptional organizational skills.
Preferred Qualifications
  • Bachelor of Science in Nursing (BSN).
  • Clinical background in Emergency Department (ER) or Intensive Care Unit (ICU).
  • Case Management experience.
  • Prior Utilization Management experience directly within a health plan or managed care organization.
  • Experience working directly with hospitals, physicians, and provider networks.
What Will Make You Successful
  • Strong clinical judgment and confidence in making accurate medical necessity determinations.
  • Ability to comfortably navigate challenging conversations regarding levels of care.
  • High organizational skills to manage multiple dynamic cases simultaneously in a fast-paced managed care environment.
  • A detail-oriented mindset committed to high-quality patient outcomes.