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Rn Utilization Management Jobs in California (NOW HIRING)

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The Utilization Review Case Manager is responsible for assessing the medical necessity ... RN State License - minimum Basic Life Support (BLS) - minimum Minimum Salary 67.50 Maximum Salary ...

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Rn Utilization Management information

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$38.5K

$88.3K

$160.9K

How much do rn utilization management jobs pay per year?

As of Aug 23, 2026, the average yearly pay for rn utilization management in California is $88,311.00, according to ZipRecruiter salary data. Most workers in this role earn between $63,700.00 and $103,100.00 per year, depending on experience, location, and employer.

What is an RN Utilization Management?

RN Utilization Management nurses are registered nurses who specialize in reviewing healthcare services to ensure patients receive appropriate and cost-effective care. They evaluate the necessity, efficiency, and quality of medical treatments and procedures, often working with insurance companies, hospitals, or healthcare organizations. Their responsibilities include reviewing patient records, coordinating with clinical staff, making coverage recommendations, and ensuring compliance with healthcare regulations. This role helps manage healthcare costs while maintaining high standards of patient care.

What skills and qualifications are needed to thrive as an RN Utilization Management?

To thrive as an RN Utilization Management Nurse, you need a current RN license, strong clinical assessment skills, and experience in care coordination or case management. Familiarity with utilization review tools, electronic health records, and knowledge of insurance guidelines or InterQual/MCG criteria are typically required. Exceptional communication, critical thinking, and negotiation skills help facilitate collaboration among providers, payers, and patients. These abilities are crucial for ensuring appropriate resource use, compliance with regulations, and optimal patient outcomes.

How does an RN Utilization Management typically collaborate with physicians and other healthcare team members?

RN Utilization Management professionals work closely with physicians, case managers, and insurance representatives to ensure patients receive appropriate, high-quality care while managing healthcare costs. They review patient records, communicate clinical findings, and may participate in interdisciplinary meetings to discuss care plans and discharge needs. Building strong relationships and maintaining open lines of communication with the care team is essential for timely authorizations and effective care coordination. This collaborative approach helps optimize patient outcomes and resource utilization.

What is the difference between Rn Utilization Management vs Rn Case Management?

AspectRn Utilization ManagementRn Case Management
CertificationsRN license, possibly certifications in utilization reviewRN license, case management certification often preferred
Work EnvironmentUtilization review departments, insurance companies, hospitalsCommunity clinics, hospitals, insurance companies
Primary FocusReviewing medical necessity and appropriateness of servicesCoordinating patient care and discharge planning

Both roles require an RN license, but Rn Utilization Management focuses on reviewing the necessity of services, while Rn Case Management emphasizes coordinating patient care. Understanding these differences helps professionals choose the right career path and employers.

How to get into utilization management as an RN?

To become an RN in utilization management, gain experience as a registered nurse, often in case management or clinical roles, and obtain knowledge of healthcare policies and insurance processes. Certifications such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ) can enhance prospects. Strong communication skills and familiarity with electronic health records (EHR) systems are also beneficial.

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

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

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

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

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

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

Rn Utilization Management jobs near you
Infographic showing various Rn Utilization Management job openings in California as of August 2026, with employment types broken down into 1% As Needed, 87% Full Time, 10% Part Time, and 2% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $88,311 per year, or $42.5 per hour.

RN - Utilization Management

Spectrum Healthcare Resources

Los Angeles, CA • On-site

Other

Posted 11 days ago

Job description


RN - Utilization Management
ID
2026-25367
Category
Registered Nurse specialties - Case Manager
Facility
Nationwide - California
Job Description

Spectrum Healthcare Resources has a need for a Utilization Manager Registered Nurse (UMRN). These will be completely remote positions, working entirely from the Nurse's home. The Nurse will be reviewing cases, educating patients on appropriate care and managing health care costs for the dependents of our Nation's Active Duty and eligible retirees.

The Nurse will be working remotely Monday through Friday, 8 hours per day.

Requirements

    Bachelors Nursing Degree
  • At least one active state nurse license, preferably compact state licensure
  • At least 2 years' experience working as a UMRN, preferably in a remote or hybrid environment.
  • Possess current certification in either
    • Completion of an accredited Certified Professional Utilization Review (CPUR) program
    • Certified Case Manager (CCM) issued by the Commission for Case Manager Certification.

--OR--

  • Possess two (2) years of full-time broad based registered nurse experience in a utilization management review or a case management setting within the preceding five (5) years. Notwithstanding the aforementioned experience requirements, the HCWs must have pertinent clinical experience within the past two (2) years sufficient to demonstrate current clinical competency for the setting and procedures required by this contract.
  • Highly organized, self-directed worker able to function in a high-volume environment without distractions.
  • Strong verbal and written communication skills.
  • Proficient level of experience with Microsoft Office applications and strong technical aptitude.
  • Must have access to secure, high speed internet.

Company Overview:

Spectrum Healthcare Resources (SHR) was established in 1988 to deliver systems and processes designed to meet the unique needs of Military and VA Health Systems. SHR is a leading organization that provides physician and clinical staffing and management services to United States Military Treatment Facilities, VA clinics and other Federal Agencies through various contracting vehicles. A Joint Commission Health Care Staffing Services firm, SHR is the military staffing division of TeamHealth, a Nationwide organization that serves 850 civilian and military hospitals with a team of 9,600 affiliated health care professionals. EOE/Disabled/Veterans

Location : Location
US-HI-Honolulu
Recruiter : Full Name: First Last
Joseph Day
Direct phone number
314-744-4138
Recruiter : Email
joseph_day@spectrumhealth.com
Spectrum Healthcare Resources logo

About Spectrum Healthcare Resources

Sourced by ZipRecruiter

Spectrum is a leading organization that provides program management and physician and clinical staffing services to United States Military Treatment Facilities, VA Clinics and Federal Agencies. We are dedicated to the markets we serve, leading our organization’s experience for almost three decades.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Saint Louis, MO, US

Year founded

1988

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