ZipRecruiter

Log In

1

Utilization Case Manager Jobs in California (NOW HIRING)

Astiva Health

Case Manager

Orange, CA · On-site

$21.25 - $27.50/hr

... utilization management, care coordination, resource utilization, and clinical documentation in accordance with the Model of Care and CMS regulations. The ACM will function within the Astiva Case ...

Loma Linda University Health

Case Manager*

Loma Linda, CA · On-site

$68.03 - $91.49/hr

Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...

Prime Staffing

Travel Case Manager

Apple Valley, CA · On-site

Travel We are seeking an experienced Acute Care RN Case Manager to coordinate patient care, discharge planning, and utilization management in a fast-paced acute care hospital. The Case Manager will ...

Astiva Health

Case Manager

Orange, CA · On-site

$75K - $90K/yr

... utilization management, care coordination, resource utilization, and clinical documentation in accordance with the Model of Care and CMS regulations. The ACM will function within the Astiva Case ...

Valley Children's Healthcare

Case Manager

Madera, CA · On-site

$60.15 - $85.81/day

Pediatric experience and Case Management/Utilization Management experience desirable. (preferred ... Skills and Abilities * Bilingual Skills Preferred. To perform this job successfully, an individual ...

Talencia

RN - Case Manager

San Pedro, CA · On-site

$68 - $72/hr

This role focuses on care coordination, utilization review, and discharge planning in an acute care setting. The RN Case Manager will manage a patient caseload, ensuring timely and appropriate care ...

Valley Children's Healthcare

Case Manager

Madera, CA

$60.15 - $85.81/day

Pediatric experience and Case Management/Utilization Management experience desirable. (preferred ... Skills and Abilities * Bilingual Skills Preferred. To perform this job successfully, an individual ...

Tenet Health

Case Manager

Joshua Tree, CA · On-site

$21.25 - $27.50/hr

Utilization Management supporting medical necessity and denial prevention * Transition Management ... Provides reports to Director of Case Management and hospital leadership as requested * Provides ...

New

Talencia

Registered Nurse - Case Manager

Mission Hills, CA · On-site

$68 - $73/hr

Job Title: Registered Nurse - Case Manager Location: Mission Hills, CA 91345 Duration: 13 weeks ... Work with HMOs, IPAs, and understand utilization review processes * Support patients with complex ...

Integrated Resources

RN Case Manager Travel

Fairfield, CA · On-site

$3.0K - $3.5K/wk

Conduct utilization review and ensure medical necessity using MCG guidelines. * Collaborate with ... Document case management activities accurately within the electronic medical record. * Monitor ...

previous page

Showing results 41-60

All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in California

Utilization Case Manager information

What is a utilization case manager?

A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.

How does a utilization case manager typically collaborate with healthcare providers and insurance companies?

Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.

What degree do I need for utilization review?

Utilization case managers typically need at least a bachelor's degree in healthcare, nursing, social work, or a related field. Some positions may require a master's degree or professional certification, such as a Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ), to advance in the role or handle complex cases.

What are the key skills and qualifications needed to thrive as a utilization case manager?

To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.

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

AspectUtilization Case ManagerUtilization Review Nurse
CredentialsRN license, case management certificationRN license, certification in utilization review
Work EnvironmentCase management teams, hospitals, insurance companiesUtilization review departments, hospitals, insurance providers
Primary FocusCoordinating patient care, discharge planning, resource allocationAssessing medical necessity, reviewing patient records for appropriateness
Common UsageBroader case management roles, patient advocacySpecific review of medical necessity and insurance claims

While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.

What are popular job titles related to Utilization Case Manager jobs in California? For Utilization Case Manager jobs in California, the most frequently searched job titles are:
What job categories do people searching Utilization Case Manager jobs in California look for? The top searched job categories for Utilization Case Manager jobs in California are:
What cities in California are hiring for Utilization Case Manager jobs? Cities in California with the most Utilization Case Manager job openings:
Utilization Case Manager jobs near you
Infographic showing various Utilization Case Manager job openings in California as of August 2026, with employment types broken down into 82% Full Time, and 18% Contract. Highlights an 82% In-person, and 18% Remote job distribution.

Case Manager*

Loma Linda University Health

Loma Linda, CA • On-site

Other

Re-posted 18 days ago

Loma Linda University Health rating

8.2

Company rating: 8.2 out of 10

Based on 88 frontline employees who took The Breakroom Quiz

97th of 1,055 rated hospitals

Job description

May work weekends and holidays depending on operational needs. 

Job Summary: The Case Manager serves as a key member of the patient care delivery team in a Magnet Recognized large tertiary academic medical center with level one trauma designation, ST-Elevation Myocardial Infarction (STEMI) receiving center designation, and Comprehensive Stroke Center and Chest Pain Center accreditation.  Works efficiently in a fast-paced environment and utilized clinical expertise, discretion and independent judgement in performing the nursing process (assessment, care planning, intervention, evaluation) within a patient-centered care professional practice model (Duffy's Quality-Caring Model) and  as it relates to case management functions. Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria (medical necessity) are met for level of care provided and is documented from admission through discharge. Practices in a collaborative health care environment to oversee implementation of a well-thought-out interdisciplinary plan of care with an individualized discharge plan that is comprehensive and best meets the continuing healthcare needs of the patient. Reevaluates plan of care and ensures continued appropriateness based on the patients changing needs and condition. Functions within the expectations of a professional nurse and meets nursing excellence standards to achieve and maintain Magnet Recognition as outlined by the American Nurses Credentialing Center. Represents nursing as an empowered profession and readily embraces new knowledge, innovations and improvements. Exhibits positivity and serves as an instrumental change agent and expertly minimizes resistance to change in the workforce, clinical practice and operational setting. Engages in opportunities to directly and/or indirectly influence decision-making for bedside clinical practice by participating in professional governance councils, committees, taskforces and staff meetings.  Performs other duties as needed.
Education and Experience: Bachelor of Science degree in nursing (BSN) required. Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred.
Knowledge and Skills: Basic knowledge of case and utilization management practice and methodologies and state and federal healthcare regulations and accreditation required.  Able to: speak, read and write legibly in English (and Spanish preferred) with professional quality; use computer, printer and software programs necessary to the position, e.g., Microsoft Office Suite, Outlook, electronic medical record, electronic event reporting program. Relate and communicate positively, effectively and exhibit professional behavior at all times; work calmly and respond courteously when under pressure; be assertive and consistent in following policies; teach, and collaborate; accept direction; think critically; work independently with minimal supervision; perform basic math and statistical functions; manage multiple assignments effectively; organize and prioritize workload; problem solve; recall information with accuracy; pay close attention to detail; hear sufficiently for general conversation in person and on the telephone; identify and distinguish various sounds associated with the work place; see adequately to read computer screens, medical records, and written documents necessary to position.
Licensures and Certifications: Active and unrestricted California Registered Nurse (RN) license required. Current Basic Life Support (BLS) certification issued by the American Heart Association required. Nationally recognized certification in Utilization Management or Case Management preferred.
 

Our mission is to continue the teaching and healing ministry of Jesus Christ. Our core values are compassion, excellence, humility, integrity, justice, teamwork and wholeness.
Loma Linda University Health is a Seventh-day Adventist, faith and values based Christian institution. Candidates must understand and embrace the mission, purpose, and identity of Loma Linda and its affiliated entities.

We are an equal opportunity employer committed to the principles of diversity. We provide equal opportunities in all aspects of the employment process to every individual, regardless of gender, race, color, age, national origin, ancestry, physical or mental disability, marital or veteran status, genetic information or any other characteristic protected by law. In addition, we will provide reasonable accommodations for otherwise qualified individuals requesting an accommodation due to a disability. If you need accommodation assistance with accessing our job listings or completing an application, or during any other phase of employment with us, please contact Human Resources Management at (909) 651-4001.

Loma Linda University Medical Center is a religiously-qualified Equal Opportunity Employer under Title VII of Civil Rights Act of 1964. No question on this application is asked for the purpose of unlawfully limiting or excluding any applicant's consideration for employment because of race, color, religion, gender, age, national origin, disability, genetic information, or any other status protected by applicable law. If you need a reasonable accommodation in the hiring process, please notify Human Resource Management.

We appreciate your interest in Loma Linda and wish you success in your job search!

What Loma Linda University Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Loma Linda University Health logo

About Loma Linda University Health

Sourced by ZipRecruiter

Loma Linda University Health (LLUH) is an esteemed healthcare organization situated in Loma Linda, California, US. Established in 1905, it was initially known as the College of Medical Evangelists, and it operated as the official medical institution of the Seventh-day Adventist Church until the name was changed to LLUH in 1961. LLUH is very much active in the healthcare and education sectors, providing a vast range of services such as medical treatment, research, and health education. The organization’s core mission is "to continue the teaching and healing ministry of Jesus Christ", which underlines its binding values of compassion, integrity, excellence, freedom, and justice.

Industry

Health care and social assistance and hospitality services

Company size

10,000+ Employees

Headquarters location

Loma Linda, CA, US

View All Loma Linda University Health Jobs

Apply