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Overnight Behavioral Health Utilization Review Jobs in Riverside, CA

KPC Health

Utilization Review Tech

Santa Ana, CA · On-site

Utilization Review Technician Under direction of the Utilization Review Technician Supervisor, the ... Ability to establish and maintain effective working relationships across the Health System

KPC Global MSO

Utilization Review Tech

Santa Ana, CA · On-site

SUMMARY Under direction of the Utilization Review Technician Supervisor, the Utilization Review ... Ability to establish and maintain effective working relationships across the Health System

Medix

Utilization Review Nurse

Orange, CA · On-site

$38 - $53/hr

Job Summary Our client is seeking a Utilization Review Nurse responsible for managing the complete ... Direct experience working within an IPA, MSO, Delegation model, or Health Plan setting. * Proven ...

Prime Healthcare

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...

Prime Healthcare

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...

Acadia Healthcare

Utilization Specialist PRN

Riverside, CA · On-site

$31 - $50/hr

Overview Pacific Grove Hospital in Riverside, CA., is a leader in behavioral healthcare, providing ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...

Prime Healthcare

Utilization Review Nurse LVN

Ontario, CA · On-site

$71K - $99K/yr

Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states ... Utilization Management experience required. * Excellent interpersonal relationship skills with ...

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Overnight Behavioral Health Utilization Review information

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$71

How much do overnight behavioral health utilization review jobs pay per hour?

As of Aug 7, 2026, the average hourly pay for overnight behavioral health utilization review in Riverside, CA is $44.11, according to ZipRecruiter salary data. Most workers in this role earn between $34.86 and $50.67 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as an overnight behavioral health utilization review specialist?

To thrive in Overnight Behavioral Health Utilization Review, you need a background in behavioral health or nursing, experience with clinical assessments, and often a state licensure such as RN, LCSW, or LMHC. Familiarity with utilization review software, electronic health records (EHR), and knowledge of insurance guidelines and medical necessity criteria like MCG or InterQual is typically required. Strong analytical skills, attention to detail, and clear written and verbal communication are essential soft skills for this role. These competencies ensure accurate, timely reviews and effective collaboration with providers, which are crucial for appropriate patient care and compliance with regulatory standards.

What are some common challenges faced by overnight behavioral health utilization review professionals, and how can they prepare for them?

One common challenge in this role is managing complex cases during off-hours when immediate resources or clinical staff may be limited. Overnight reviewers often need to make timely, well-informed decisions with less direct support, so strong critical thinking and autonomous decision-making skills are essential. Additionally, effective communication with healthcare providers and payers is crucial, even when working remotely or asynchronously. Job seekers can prepare by familiarizing themselves with behavioral health protocols, building strong documentation habits, and developing confidence in interpreting clinical guidelines.

What is an overnight behavioral health utilization review?

An Overnight Behavioral Health Utilization Review is a process conducted by healthcare professionals, often during nighttime hours, to assess and determine the medical necessity of behavioral health treatments, such as psychiatric inpatient admissions or continued stays. These reviews ensure that patients receive appropriate care while ensuring compliance with insurance policies and regulatory guidelines. The overnight aspect allows hospitals and facilities to process urgent cases and obtain authorizations outside of regular business hours, helping maintain uninterrupted patient care. Utilization reviewers collaborate with providers, insurance companies, and clinical teams to evaluate treatment plans and resource utilization.
What are the most commonly searched types of Behavioral Health Utilization Review jobs in Riverside, CA? The most popular types of Behavioral Health Utilization Review jobs in Riverside, CA are:
What cities near Riverside, CA are hiring for Overnight Behavioral Health Utilization Review jobs? Cities near Riverside, CA with the most Overnight Behavioral Health Utilization Review job openings:
Overnight Behavioral Health Utilization Review jobs near you

Utilization Review Tech

KPC Health

Santa Ana, CA • On-site

Other

Posted 4 days ago

Job description

Utilization Review Technician

Under direction of the Utilization Review Technician Supervisor, the Utilization Review Technician coordinates with the Utilization Management Department while being responsible for coordinating phone calls, clinical requests, upkeeps data entry, organizes denials and mailing/faxing appeals, tracking data from various insurance providers and health plans regarding authorization and/or denials, expedite reviews and documentation to insurance providers. Monitors patient charts and records to provide to responsible parties and request for authorization for hospital admission. Reviews treatment plans and status of approvals from insurers. Collects and compiles data as required and according to applicable policies and regulations. Performs administrative duties for the Utilization Management Department, and directed in several aspects of duties. Position is non-RN/LVN.

Requirements
  • Ability to establish and maintain effective working relationships across the Health System
  • Ability to interpret and understand various medical insurance plans and make accurate determinations regarding coverage
  • Follow up with insurance companies regarding the status of outstanding claims and necessary steps for resolution
  • Answer and review pertinent insurance correspondence to ensure complete and accurate reimbursement for medical claims
  • Responsible for working payer correspondence, edits and aged account receivable, and identifying and correcting billing errors
  • Pull daily reports utilizing Microsoft Excel and providing correct correspondence to payer
  • Research payer rules and regulations to maintain current payer knowledge
  • Comply with HIPAA and other compliance requirements to protect patient confidentiality
  • Manage data in internal and external databases with accuracy
  • Provide high-level administrative support and assistance to the Director and Supervisor or other assigned leadership staff
  • Perform clerical and administrative tasks including drafting letters, memos, invoices, reports, and other documents for senior staff
  • Prepare patient charts for medical audits
Education & Experience Requirements:
  • High School Diploma
  • Healthcare experience strongly preferred
Skills & Abilities Requirements:
  • Excellent verbal and written communication skills
  • Excellent organizational skills and attention to detail
  • Excellent time management skills with a proven ability to meet deadlines
  • Ability to function well in a high-paced and at times stressful environment
  • Extensive knowledge of office administration, clerical procedures, and recordkeeping systems
  • Able to type minimum of 50 words per minute
  • Knowledge of CMS, State Regulations, URAC and NCQA guidelines preferred.
  • ICD-10 and CPT coding experience a plus
  • Experienced computer skills with Microsoft Word, Microsoft Outlook, Excel and experience working in a health plan medical management documentation system a plus
  • Extremely proficient with Microsoft Office Suite or similar software with the ability to learn new or updated software
  • Medical Terminology preferred
Physical Requirements:
  • 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.
Working Environment:
  • Work in an office, where the climate is controlled.
  • OSHA exposure category: II
  • 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.
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About KPC Health

Sourced by ZipRecruiter

KPC Health has an integrated approach to serving the people of Riverside, San Bernardino and Orange County. Our acute care medical centers provide high quality, comprehensive and affordable healthcare for the entire family. For us, healthcare is not just about caring for our patients, but also about investing in the people throughout our communities. We are one team with one mission and that mission is for all our patients, and their families to Enjoy Life in Great Health.

Industry

Health care and social assistance

Company size

201 - 500 Employees

Headquarters location

Santa Ana, CA, US

Year founded

2004

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