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Rn Utilization Management Jobs in California (NOW HIRING)

Dignity Health

Utilization Management RN

Bakersfield, CA · On-site

$57.37 - $85.33/hr

Job Summary and Responsibilities As our UM RN (Utilization Management Registered Nurse), you will be responsible for ensuring the integrity of the adverse determination processes and accuracy of ...

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Rn Utilization Management information

See California salary details

$38.5K

$88.3K

$160.9K

How much do rn utilization management jobs pay per year?

As of Aug 11, 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.

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 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 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 insurance policies and healthcare regulations. 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 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.

What does a utilization management registered nurse do?

A utilization management registered nurse reviews patient cases to determine the necessity, appropriateness, and efficiency of healthcare services and treatments. They analyze medical records, collaborate with healthcare providers, and ensure compliance with insurance and regulatory guidelines, often using electronic health records and clinical judgment. Certification in case management or utilization review is commonly required for this role.

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 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, 81% Full Time, 14% Part Time, 2% Temporary, and 2% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $88,311 per year, or $42.5 per hour.

Registered Nurse - Utilization Management

myPlace Health

Los Angeles, CA • On-site

$53K - $58K/yr

Full-time

Retirement

Posted 26 days ago

Job description

About the Role

Join myPlace Health as a Registered Nurse - Utilization Management in Los Angeles, CA. myPlace Health specializes in providing value-based, comprehensive care and coverage for older adults with significant needs, enabling them to thrive in their homes. In this full-time role, you will play a crucial part in ensuring participants receive appropriate and efficient care through our myPlace PACE model, which provides seamless primary care, integrated health plan coverage, and personalized social engagement.

Key Responsibilities
  • Conduct utilization reviews for medical services to ensure alignment with established guidelines and participant care plans.
  • Assess the medical necessity of admissions, continued stays, and ancillary services.
  • Collaborate with interdisciplinary teams, including physicians, social workers, and other healthcare professionals, to optimize participant outcomes.
  • Document all review activities accurately and thoroughly in accordance with regulatory standards and myPlace Health policies.
  • Identify trends and opportunities for improvement in care delivery and resource utilization.
  • Provide comprehensive reports on utilization management activities and outcomes.
  • Participate in ongoing training and professional development to maintain expertise in utilization management.
Required Qualifications & Experience

Required:

  • 3 years of experience as a Registered Nurse.

Preferred:

  • None specified
Benefits
  • Health insurance
  • Paid time off (PTO)
  • 401(k) match
  • Dental insurance
  • Paid holidays
  • Vision insurance
  • 401(k)