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 ...
New
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 ...
New
Utilization Specialist PRN
$31 - $50/hr
Act as liaison between managed care organizations and the facility professional clinical staff ... Monitor patient length of stay and extensions and inform clinical and medical staff on issues that ...
Utilization Specialist PRN
$31 - $50/hr
Act as liaison between managed care organizations and the facility professional clinical staff ... Monitor patient length of stay and extensions and inform clinical and medical staff on issues that ...
Medical Director Designee
Riverside, CA · On-site
Medical Director Designee Reports To: Administrator Appointed By: Governing Body (in writing ... ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES • Devoting best ability to the proper management and ...
Quick apply
Medical Director Designee
Riverside, CA · On-site
Medical Director Designee Reports To: Administrator Appointed By: Governing Body (in writing ... ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES • Devoting best ability to the proper management and ...
Hospice Medical Director
Ontario, CA · On-site
Support clinical excellence, hospice eligibility determinations, care planning, symptom management ... medical director or other administrator role Why AccentCare? Caring for others is more than what ...
Hospice Medical Director
Ontario, CA · On-site
Support clinical excellence, hospice eligibility determinations, care planning, symptom management ... medical director or other administrator role Why AccentCare? Caring for others is more than what ...
Hospice Medical Director
Ontario, CA · On-site
$12K - $15K/yr
Support clinical excellence, hospice eligibility determinations, care planning, symptom management ... in a medical director or other administrator role Qualifications Caring for others is more than ...
Quick apply
Hospice Medical Director
Ontario, CA · On-site
$12K - $15K/yr
Support clinical excellence, hospice eligibility determinations, care planning, symptom management ... in a medical director or other administrator role Qualifications Caring for others is more than ...
Chief Psychiatric Medical Director*
San Bernardino, CA · On-site
$498K/yr
They will supervise a direct staff of seven, consisting of associate medical directors and nurse managers, up to 200 indirect reports, and an approximate budget of $43 million. The ideal candidate is ...
Chief Psychiatric Medical Director*
San Bernardino, CA · On-site
$498K/yr
They will supervise a direct staff of seven, consisting of associate medical directors and nurse managers, up to 200 indirect reports, and an approximate budget of $43 million. The ideal candidate is ...
Chief Psychiatric Medical Director*
$345K - $498K/yr
They will supervise a direct staff of seven, consisting of associate medical directors and nurse managers, up to 200 indirect reports, and an approximate budget of $43 million. The ideal candidate is ...
Chief Psychiatric Medical Director*
$345K - $498K/yr
They will supervise a direct staff of seven, consisting of associate medical directors and nurse managers, up to 200 indirect reports, and an approximate budget of $43 million. The ideal candidate is ...
Utilization Specialist PRN
$31 - $50/hr
Act as liaison between managed care organizations and the facility professional clinical staff ... Conduct quality reviews for medical necessity and services provided. * Facilitate peer review calls ...
Utilization Specialist PRN
$31 - $50/hr
Act as liaison between managed care organizations and the facility professional clinical staff ... Conduct quality reviews for medical necessity and services provided. * Facilitate peer review calls ...
Utilization Specialist PRN
Riverside, CA · On-site
$31 - $50/hr
Act as liaison between managed care organizations and the facility professional clinical staff ... Conduct quality reviews for medical necessity and services provided. * Facilitate peer review calls ...
Utilization Specialist PRN
Riverside, CA · On-site
$31 - $50/hr
Act as liaison between managed care organizations and the facility professional clinical staff ... Conduct quality reviews for medical necessity and services provided. * Facilitate peer review calls ...
Director of Clinical Services
Irvine, CA · On-site
NTT DATA currently seeks a Director of Clinical Services to join our team in Irvine, CA. Job ... utilization management, population health, wellness, or medical management initiatives. * Active ...
Director of Clinical Services
Irvine, CA · On-site
NTT DATA currently seeks a Director of Clinical Services to join our team in Irvine, CA. Job ... utilization management, population health, wellness, or medical management initiatives. * Active ...
Chief Psychiatric Medical Director*
San Bernardino, CA · On-site
$498K/yr
They will supervise a direct staff of seven, consisting of associate medical directors and nurse managers, up to 200 indirect reports, and an approximate budget of $43 million. The ideal candidate is ...
Chief Psychiatric Medical Director*
San Bernardino, CA · On-site
$498K/yr
They will supervise a direct staff of seven, consisting of associate medical directors and nurse managers, up to 200 indirect reports, and an approximate budget of $43 million. The ideal candidate is ...
Director, Case Management
Santa Ana, CA · On-site
... utilization management, discharge planning, and outcomesmanagement. * Oversees the MediCal TAR ... organizing, directing, motivating,controlling and decision making. * Ability to communicate ...
Director, Case Management
Santa Ana, CA · On-site
... utilization management, discharge planning, and outcomesmanagement. * Oversees the MediCal TAR ... organizing, directing, motivating,controlling and decision making. * Ability to communicate ...
Chief Psychiatric Medical Director*
San Bernardino, CA · On-site
$345K - $498K/yr
They will supervise a direct staff of seven, consisting of associate medical directors and nurse managers, up to 200 indirect reports, and an approximate budget of $43 million. The ideal candidate is ...
Chief Psychiatric Medical Director*
San Bernardino, CA · On-site
$345K - $498K/yr
They will supervise a direct staff of seven, consisting of associate medical directors and nurse managers, up to 200 indirect reports, and an approximate budget of $43 million. The ideal candidate is ...
... Utilization Management (UM) department, and it supports delegated UM operations in a California managed care environment. The Clinical Review Nurse works closely with providers, Medical Directors ...
... Utilization Management (UM) department, and it supports delegated UM operations in a California managed care environment. The Clinical Review Nurse works closely with providers, Medical Directors ...
Physician Medical Director
Rancho Cucamonga, CA · On-site
$250/hr
Center Medical Director Stipend At Concentra, our Medical Directors spend the majority of their ... Manages clinicians, support staff, and complies with APC supervisory requirements. * Creates a ...
Physician Medical Director
Rancho Cucamonga, CA · On-site
$250/hr
Center Medical Director Stipend At Concentra, our Medical Directors spend the majority of their ... Manages clinicians, support staff, and complies with APC supervisory requirements. * Creates a ...
This role offers an opportunity for physicians to blend their love of patient care with their management skills, working for the leader in the workplace health industry. As a Clinic Medical Director ...
This role offers an opportunity for physicians to blend their love of patient care with their management skills, working for the leader in the workplace health industry. As a Clinic Medical Director ...
This role offers an opportunity for physicians to blend their love of patient care with their management skills, working for the leader in the workplace health industry. As a Clinic Medical Director ...
This role offers an opportunity for physicians to blend their love of patient care with their management skills, working for the leader in the workplace health industry. As a Clinic Medical Director ...
This role offers an opportunity for physicians to blend their love of patient care with their management skills, working for the leader in the workplace health industry. As a Clinic Medical Director ...
This role offers an opportunity for physicians to blend their love of patient care with their management skills, working for the leader in the workplace health industry. As a Clinic Medical Director ...
Physician Medical Director
Rancho Cucamonga, CA · On-site
$250/hr
This role offers an opportunity for physicians to blend their love of patient care with their management skills, working for the leader in the workplace health industry. As a Clinic Medical Director ...
Physician Medical Director
Rancho Cucamonga, CA · On-site
$250/hr
This role offers an opportunity for physicians to blend their love of patient care with their management skills, working for the leader in the workplace health industry. As a Clinic Medical Director ...
This role offers an opportunity for physicians to blend their love of patient care with their management skills, working for the leader in the workplace health industry. As a Clinic Medical Director ...
This role offers an opportunity for physicians to blend their love of patient care with their management skills, working for the leader in the workplace health industry. As a Clinic Medical Director ...
Medical Director Utilization Management information
See Riverside, CA salary details
$13.6K - $46.2K
2% of jobs
$46.2K - $78.8K
1% of jobs
$78.8K - $111.4K
5% of jobs
$111.4K - $144.1K
3% of jobs
$144.1K - $176.7K
5% of jobs
$206.3K is the 25th percentile. Wages below this are outliers.
$176.7K - $209.3K
9% of jobs
$209.3K - $241.9K
19% of jobs
The median wage is $249.3K / yr.
$241.9K - $274.6K
22% of jobs
$290.4K is the 75th percentile. Wages above this are outliers.
$274.6K - $307.2K
17% of jobs
$307.2K - $339.8K
10% of jobs
$339.8K - $372.4K
6% of jobs
$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?
| Aspect | Medical Director Utilization Management | Medical Director Case Management |
|---|---|---|
| Credentials | Medical degree, medical license, possibly board certification | Medical degree, medical license, possibly board certification |
| Work Environment | Utilization review departments, insurance companies, healthcare organizations | Case management teams, hospitals, healthcare providers |
| Employer & Industry | Insurance companies, managed care organizations | Hospitals, healthcare systems, community health agencies |
| Primary Focus | Reviewing medical necessity and approving services | Coordinating 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:
Other
Posted 3 days ago
New
Job description
SUMMARY
The Utilization Review RN reviews client health records to ensure proper utilization of treatment resources.
RESPONSIBILITIES AND DUTIES:
EDUCATION & EXPERIENCE REQUIREMENTS:
The Utilization Review RN reviews client health records to ensure proper utilization of treatment resources.
RESPONSIBILITIES AND DUTIES:
- Coordinates and reviews all medical records, as assigned to caseload.
- Actively participates in Case Management and Treatment Team meetings
- Serves as on-going educator to all departments.
- Responsible for reviewing patient charts in order to assess whether the criteria for admission and continuation of treatment is being met; gathering data and responding to request for records from fiscal intermediary; gathering clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting
- Able to work independently and use sound judgment.
- Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment.
- Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families.
- Performs other duties as assigned.
EDUCATION & EXPERIENCE REQUIREMENTS:
- Bachelor's or Master's degree in social work, behavioral or mental health, nursing or other related health field preferred.
- CA RN License Required
- Minimum of 2 years' experience with the population of the facility and previous experience in utilization management preferred.
- Communication
- Planning & Organizing
- Problem Solving
- Attention to Detail
- Body Positions: Sitting and standing for prolonged periods.
- Body Movements: Arm and hand dexterity.
- Body Senses: Must have command of close and distant sight, color perception and hearing.
- Strength: Ability to lift and move up to 25-pounds.
- Work in an office, where the climate is controlled.
- OSHA exposure category: I
- Category I - Position includes tasks that involve exposure to Blood borne Pathogens.
- Category II - Position includes tasks that do not have exposure to Bloodborne Pathogens, however employment may require unplanned Category I tasks.
- Category III - Positions includes tasks that do not involve exposure to Bloodborne Pathogens. This position would not be required to perform Category I tasks.