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Medical Director Utilization Management Jobs in Riverside, CA

Aroha Technologies

Medical Case Manager (LVN)

Orange, CA · On-site

$37.43 - $45/hr

... utilization management or care management systems. * Determine the appropriate action for requested services, including approval, modification, or denial. * Refer cases to the Medical Director for ...

Astiva Health, Inc

UM Nurse Reviewer

Orange, CA · On-site

... medical necessity. * Collaborate with healthcare providers, the Utilization Management (UM) team, and compliance departments to ensure clear communication and appropriate utilization of healthcare ...

National Veterinary Associates

Medical Director

Redlands, CA · On-site

$180K - $200K/yr

East Valley Pet Hospital in Redlands, CA is looking for a Medical Director to lead our exceptional ... Paid time off Your Role as Managing Veterinarian: * Provide medical leadership and ensure top-tier ...

OneTogether Solutions

Clinic Medical Director

Perris, CA · On-site

$300K - $375K/yr

The Clinic Medical Director also collaborates with OneTogether Solutions (OTS) support staff ... Risk management and problem resolution. * Fostering a culture of accountability, collaboration ...

NVA

Medical Director

Redlands, CA · On-site

$180K - $200K/yr

East Valley Pet Hospital in Redlands, CA is looking for a Medical Director to lead our exceptional ... Collaborate with practice management to drive growth and efficiency * Foster a culture of ...

KPC Health

Utilization Review RN

Santa Ana, CA · On-site

... all medical records, as assigned to caseload. * Actively participates in Case Management and ... Utilization Review and Case Management reporting * Able to work independently and use sound ...

Astiva Health

UM Nurse Reviewer

Orange, CA · On-site

... medical necessity. * Collaborate with healthcare providers, the Utilization Management (UM) team, and compliance departments to ensure clear communication and appropriate utilization of healthcare ...

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Showing results 21-40

All JobsMedical Utilization Management JobsMedical Director Utilization Management JobsMedical Director Utilization Management Jobs in Riverside, CA

Medical Director Utilization Management information

See Riverside, CA salary details

$13.6K

$242.4K

$372.4K

How much do medical director utilization management jobs pay per year?

As of Sep 8, 2026, the average yearly pay for medical director utilization management in Riverside, CA is $242,423.00, according to ZipRecruiter salary data. Most workers in this role earn between $206,600.00 and $296,800.00 per year, depending on experience, location, and employer.

What is a medical director utilization management?

A Medical Director of Utilization Management is a physician who oversees and ensures the appropriate use of medical resources within a healthcare organization or insurance company. Their responsibilities include reviewing clinical cases, developing utilization review policies, and working with healthcare providers to ensure that treatment plans are medically necessary and cost-effective. They play a key role in balancing patient care quality with regulatory and financial considerations, helping to improve healthcare outcomes and system efficiency.

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

To thrive as a Medical Director Utilization Management, you need a medical degree (MD or DO), board certification, and extensive clinical experience, often in internal medicine or a related specialty. Familiarity with utilization review processes, case management software, and regulatory frameworks such as CMS guidelines is essential. Strong leadership, analytical thinking, and effective communication skills are crucial for guiding teams and collaborating with diverse stakeholders. These competencies ensure appropriate resource utilization, regulatory compliance, and high-quality patient care within healthcare organizations.

How does a medical director utilization management typically collaborate with clinical teams and insurance providers?

A Medical Director in Utilization Management frequently works at the intersection of healthcare providers, clinical teams, and insurance companies. Their role involves reviewing clinical cases, making coverage determinations, and consulting with physicians to ensure that medical treatments are both necessary and cost-effective. Collaboration often includes participating in interdisciplinary meetings, providing guidance on complex cases, and communicating policy updates or clinical guidelines. This ensures that patient care decisions align with best practices, regulatory requirements, and payer policies.

What is the difference between Medical Director Utilization Management vs Medical Director Case Management?

AspectMedical Director Utilization ManagementMedical Director Case Management
CredentialsMedical degree, medical license, possibly board certificationMedical degree, medical license, possibly board certification
Work EnvironmentUtilization review departments, insurance companies, healthcare organizationsCase management teams, hospitals, healthcare providers
Employer & IndustryInsurance companies, managed care organizationsHospitals, healthcare systems, community health agencies
Primary FocusReviewing medical necessity and approving servicesCoordinating patient care and discharge planning

Both roles require medical credentials and involve improving patient care, but Medical Director Utilization Management primarily focuses on reviewing and approving healthcare services for insurance purposes, while Medical Director Case Management emphasizes coordinating ongoing patient care and discharge planning within healthcare settings.

What are popular job titles related to Medical Director Utilization Management jobs in Riverside, CA?

For Medical Director Utilization Management jobs in Riverside, CA, the most frequently searched job titles are:

What job categories do people searching Medical Director Utilization Management jobs in Riverside, CA look for?

The top searched job categories for Medical Director Utilization Management jobs in Riverside, CA are:

What cities near Riverside, CA are hiring for Medical Director Utilization Management jobs?

Cities near Riverside, CA with the most Medical Director Utilization Management job openings:

Medical Director Utilization Management jobs near you

Medical Case Manager (LVN)

Aroha Technologies

Orange, CA • On-site

$37.43 - $45/hr

Contractor

Posted 6 days ago

Job description

Temporary Medical Case Manager (LVN) – CalAIM

Location: 505 City Parkway West, Orange County, CA
Job Type: Temporary / Contract
Assignment Duration: Up to 6 months
Schedule: Monday–Friday, 8:00 AM–5:00 PM
Work Arrangement: Fully Onsite
Pay: $37.43–$45.00 per hour, W-2
Target compensation is expected to be around the mid-range or below, depending on qualifications and experience.

About the Role

We are seeking an experienced Licensed Vocational Nurse (LVN) to join our CalAIM team as a Temporary Medical Case Manager. This position supports care coordination and utilization management activities for CalAIM services, ensuring requests are reviewed appropriately and members receive timely, high-quality support.

The ideal candidate will have strong clinical judgment, excellent communication skills, and the ability to work independently in a fast-paced healthcare environment. Experience with managed care or authorization review is highly preferred.

Key Responsibilities

  • Review authorization requests for CalAIM services for medical appropriateness using established clinical criteria, policies, and procedures.

  • Verify and process CalAIM referrals received through healthcare systems, telephone, and fax.

  • Apply established clinical protocols to determine medical necessity.

  • Coordinate member care with health networks, healthcare providers, internal teams, patients, and families.

  • Accurately document authorization decisions, clinical information, and updates in utilization management or care management systems.

  • Determine the appropriate action for requested services, including approval, modification, or denial.

  • Refer cases to the Medical Director for review when appropriate.

  • Contact members, families, and CalAIM providers to obtain additional information as needed.

  • Support department goals and priorities while maintaining a member-focused, mission-driven approach.

  • Meet established productivity, quality, documentation, and performance standards.

  • Collaborate effectively with internal departments and external healthcare partners.

  • Perform other duties and projects as assigned.

Required Qualifications

  • Current, unrestricted California LVN license required.

  • High school diploma or equivalent.

  • At least 3 years of nursing experience.

  • Strong clinical judgment and problem-solving skills.

  • Excellent verbal and written communication abilities.

  • Ability to work independently and manage multiple priorities.

  • Proficiency with Microsoft Office applications, including Word, Outlook, Excel, and PowerPoint.

  • Ability to work effectively in a fast-paced environment.

Preferred Qualifications

  • Experience in managed care.

  • At least 1 year of authorization review experience.

  • Experience with utilization management, care management, or medical necessity review.

  • Bilingual in English and one of the following threshold languages: Arabic, Farsi, Chinese, Korean, Spanish, or Vietnamese.

Yashika Jaint
Healthcare Recruiter
510-400-6494