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Utilization Care Manager Jobs in California (NOW HIRING)

AHMC Healthcare

CARE MANAGER

Daly City, CA

$68 - $72/hr

The Case Manager RN is responsible for ensuring effective and efficient utilization of hospital resources and assisting patients in receiving appropriate, high quality post hospital care and service.

AHMC Healthcare

CARE MANAGER

Daly City, CA · On-site

$68/hr

Overview The Case Manager RN is responsible for ensuring effective and efficient utilization of hospital resources and assisting patients in receiving appropriate, high quality post hospital care and ...

AHMC Healthcare

CARE MANAGER

Daly City, CA · On-site

Overview The Case Manager RN is responsible for ensuring effective and efficient utilization of hospital resources and assisting patients in receiving appropriate, high quality post hospital care and ...

LabMinds Staffing & Recruiting

Care Manager

Chico, CA · On-site

The role combines clinical assessment, care planning, utilization management, and patient advocacy to support quality, efficient, and cost-effective outcomes. Key Responsibilities: * Coordinate ...

Care Navigators On Demand

Care Manager

Whittier, CA · On-site

... clinical care, utilization of resources, and development of new clinical tools, forms, and ... Requirements for Care Manager: • Current unrestricted RN License or LCSW/MSW or Advance degree in ...

Care Navigators On Demand

Care Manager

Santa Monica, CA · On-site

... clinical care, utilization of resources, and development of new clinical tools, forms, and ... Requirements for Care Manager: • Current unrestricted RN License or LCSW/MSW or Advance degree in ...

Care Navigators On Demand

Care Manager

Fullerton, CA · On-site

... clinical care, utilization of resources, and development of new clinical tools, forms, and ... Requirements for Care Manager: • Current unrestricted RN License or LCSW/MSW or Advance degree in ...

Care Navigators On Demand

Care Manager

Riverside, CA · On-site

... clinical care, utilization of resources, and development of new clinical tools, forms, and ... Requirements for Care Manager: • Current unrestricted RN License or LCSW/MSW or Advance degree in ...

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All JobsUtilization Care JobsUtilization Care Manager JobsUtilization Care Manager Jobs in California

Utilization Care Manager information

What is a utilization care manager?

Utilization Care Managers are healthcare professionals responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They work to ensure that patients receive the right care at the right time, while also helping healthcare organizations manage costs and comply with regulations. Utilization Care Managers often review patient cases, coordinate with medical staff, and interact with insurance companies to authorize or deny services. Their goal is to optimize healthcare delivery, reduce unnecessary procedures, and improve patient outcomes.

How does a utilization care manager collaborate with medical and administrative teams to ensure effective patient care?

Utilization Care Managers work closely with physicians, nursing staff, and administrative teams to review patient cases, determine medical necessity, and coordinate appropriate care plans. They frequently participate in interdisciplinary meetings, communicate with insurance providers regarding authorizations, and ensure compliance with regulatory guidelines. This collaborative approach helps to optimize resource utilization, improve patient outcomes, and support smooth transitions of care. Being proactive in communication and documentation is key to success in this role.

What are the key skills and qualifications needed to thrive as a utilization care manager, and why are they important?

To thrive as a Utilization Care Manager, you need a background in healthcare, typically as a registered nurse or social worker, with expertise in care coordination and utilization review. Familiarity with utilization management software, medical necessity guidelines (such as Milliman or InterQual), and knowledge of insurance regulations are important. Strong analytical thinking, attention to detail, and effective communication skills help you advocate for patients while working with healthcare teams and payers. These skills ensure appropriate resource use, quality patient outcomes, and compliance with regulatory standards.

What is the difference between Utilization Care Manager vs Utilization Review Nurse?

AspectUtilization Care ManagerUtilization Review Nurse
CredentialsRN, case management certificationRN, certification in utilization review
Work EnvironmentHealthcare facilities, insurance companiesHospitals, insurance companies, outpatient clinics
Primary FocusCoordinating patient care, managing resourcesReviewing medical necessity, approving treatments

Utilization Care Managers focus on coordinating patient care and managing resources, while Utilization Review Nurses primarily evaluate medical necessity for treatments. Both roles require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

What does a utilization care manager do in healthcare?

A utilization care manager in healthcare reviews patient cases to ensure appropriate use of medical services and resources, coordinating care plans to optimize patient outcomes and reduce unnecessary costs. They often work with healthcare providers, insurance companies, and patients, using data and clinical guidelines to make informed decisions about treatment and service utilization.

What are popular job titles related to Utilization Care Manager jobs in California?

For Utilization Care Manager jobs in California, the most frequently searched job titles are:

What job categories do people searching Utilization Care Manager jobs in California look for?

The top searched job categories for Utilization Care Manager jobs in California are:

What cities in California are hiring for Utilization Care Manager jobs?

Cities in California with the most Utilization Care Manager job openings:

Utilization Care Manager jobs near you
Infographic showing various Utilization Care Manager job openings in California as of August 2026, with employment types broken down into 2% As Needed, 74% Full Time, 18% Part Time, and 6% Contract. Highlights an 93% Physical, 1% Hybrid, and 6% Remote job distribution.

Care Manager (Case Management)

Redlands Community Hospital - UTILIZATION MANAGEMENT

Redlands, CA • On-site

$49.98 - $72.47/hr

Full-time

Re-posted 9 days ago

Job description




Hourly pay range: $49.98 min. - $72.47 max


This position reports to the Director, Case Management the Care Manager position is to support the physician and interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers. The role integrates and coordinates utilization management, care facilitation and discharge planning functions. The Care Manager is accountable for a designated patient caseload and plans effectively to meet patient needs, manage the length of stay, and promote efficient utilization of resources. In addition, the Care Manager helps drive change by identifying areas where performance improvement is needed (e.g., day to day workflow, education, process improvements, patient satisfaction) .


*Ability to meet all job & physical requirements as outlined in job description or as agreed through a work place accommodation.


EDUCATION/TRAINING/ EXPERIENCE:

  1. BS degree in nursing from an accredited school of nursing preferred.
  2. Three or more years strong clinical experience in clinical practice area to which assigned preferred.
  3. Strong analytical, data management, and computer skills desired.


CERTIFICATIONS/LICENSES:

  1. Current California State License as a Registered Nurse required.
  2. Current CPR certification required.
  3. Case Management (ACM or CCM) certification preferred.
  4. MAB certification required within 3 months of hire if assigned to the Emergency department.

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