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Part Time Utilization Management Jobs in California

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Registered Nurse (RN)

Pomona, CA · On-site

$52 - $57/hr

The Registered Nurse (RN) in Utilization Management (UM) specializing in appeals and denials ... option to extend Hours - Part Time - Day 3x8-Hour (08:00 - 16:30) = 24 hours per week ...

Loma Linda University Health

Case Manager

Murrieta, CA · On-site

$59.18 - $79.60/hr

Case Management and Social- ( Part Time, Varied Shift) - Job Summary: The Case Manager serves as a ... Maintains a solid working knowledge of specialized case and utilization management methodologies ...

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Part Time Utilization Management information

What is the difference between Part Time Utilization Management vs Part Time Care Coordinator?

AspectPart Time Utilization ManagementPart Time Care Coordinator
Primary RoleReviewing and approving healthcare services to ensure appropriate utilizationCoordinating patient care plans and services across providers
CertificationsTypically requires healthcare or insurance-related certificationsOften requires healthcare or case management certifications
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHealthcare facilities, clinics, or community health settings
Employer & Industry UsageInsurance companies, managed care organizationsHospitals, clinics, healthcare providers

While both roles involve healthcare coordination, Part Time Utilization Management focuses on reviewing and authorizing services, whereas Part Time Care Coordinators actively manage patient care plans. Understanding these differences helps in choosing the right career path or job search focus.

What are the key skills and qualifications needed to thrive as a Part Time Utilization Management professional, and why are they important?

To thrive as a Part Time Utilization Management professional, you need a background in nursing or healthcare, critical thinking skills, and knowledge of medical necessity criteria, often supported by RN or LPN licensure. Familiarity with utilization review software, electronic health records (EHRs), and systems like InterQual or Milliman is typically required. Strong communication, attention to detail, and organizational skills help you effectively coordinate with providers and ensure accurate documentation. These abilities are essential for making informed coverage determinations, optimizing resource use, and maintaining compliance with healthcare regulations.

What is a part-time utilization management job?

A part-time utilization management job involves reviewing and evaluating the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities on a part-time basis. These professionals help ensure that patients receive the right care at the right time while controlling healthcare costs and complying with insurance policies. Part-time roles may be suitable for nurses, social workers, or other healthcare professionals who want flexible hours while contributing to quality patient care and resource management.
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 cities in California are hiring for Part Time Utilization Management jobs? Cities in California with the most Part Time Utilization Management job openings:
Part Time Utilization Management jobs near you

Medical Director - Utilization Management (Part Time)

Astrana Health, Inc.

Monterey Park, CA • On-site, Remote

$250K - $325K/yr

Part-time

Posted 26 days ago

Job description

Medical Director - Utilization Management (Part Time)
Department: HS - UM
Employment Type: Part Time
Location: 1600 Corporate Center Dr., Monterey Park, CA 91754
Reporting To: Dr. Dinesh Kumar
Description
About the Role
The Part‑Time Medical Director - Utilization Management, Outpatient Services provides physician oversight for medical necessity, appropriateness, and utilization decisions across Astrana Health's outpatient, ancillary, and professional services. This role supports Astrana's delegated risk arrangements by ensuring compliant, evidence‑based utilization while partnering closely with outpatient clinical leadership, UM operations, and health plan stakeholders.
What You'll Do
  • Provide physician oversight and final determination for outpatient utilization management activities, including prior authorizations, retrospective reviews, and appeals.
  • Ensure medical necessity and appropriateness of outpatient services such as specialty referrals, diagnostics, imaging, DME, therapies, and procedures.
  • Support compliance with delegated health plan requirements, regulatory standards, and accreditation guidelines.
  • Conduct peer‑to‑peer reviews and outpatient physician education to improve documentation, guideline adherence, and appropriate utilization.
  • Partner with Outpatient Medical Directors, Population Health, and UM nursing teams to align utilization decisions with Astrana's value‑based care strategy.
  • Identify outpatient utilization trends, leakage, and variation; recommend clinical strategies to improve cost efficiency and quality outcomes.
  • Serve as clinical liaison with health plans and external vendors on outpatient UM‑related matters.

Qualifications
  • MD or DO; Board Certified in Internal Medicine, Family Medicine, or a relevant outpatient specialty required.
  • Active, unrestricted medical license (California required).
  • Prior experience in outpatient utilization management, health plan medical management, or delegated risk environments.
  • Strong understanding of outpatient medical necessity criteria, prior authorization workflows, and appeals processes.
  • Experience working with PCPs and ambulatory specialists in value‑based care models.
  • Strong physician‑to‑physician communication and clinical judgment.

Environmental Job Requirements and Working Conditions
  • This is a Remote - US based position.
  • The national target base salary range for this role is: $250,000 - $325,000. Actual compensation will be determined based on geographic location (current or future), experience, or other job-related factors.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

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