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Utilization Case Manager Jobs in Brea, CA (NOW HIRING)

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 ...

Prime Staffing

Travel Utilization Review RN

Orange, CA · On-site

Prime Staffing is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Orange, California. & Requirements * Specialty: Utilization Review * Discipline: RN * Start ...

New

memorial care

RN, Case Manager III (UR)

Long Beach, CA · On-site

$61.98/hr

The incumbent is accountable for education, monitoring, utilization and evaluation of medical outcomes. Essential Job Outcomes & Functions Care Management Case Management The case manager III ...

memorial care

RN, Case Manager III (UR)

Long Beach, CA · On-site

$61.98/hr

The incumbent is accountable for education, monitoring, utilization and evaluation of medical outcomes. Essential Job Outcomes & Functions Care Management Case Management The case manager III ...

MemorialCare

RN, Case Manager III (UR)

Long Beach, CA · On-site

$129 - $180/hr

The incumbent is accountable for education, monitoring, utilization and evaluation of medical outcomes. Essential Job Outcomes & Functions Care Management Case Management The case manager III ...

Encompass Health

Case Manager

Tustin, CA

$21 - $27/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

MemorialCare

RN, Case Manager III (UR)

Long Beach, CA · On-site

$61.98 - $86.73/hr

The incumbent is accountable for education, monitoring, utilization and evaluation of medical outcomes. Essential Job Outcomes & Functions Care Management Case Management The case manager III ...

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Utilization Case Manager information

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How much do utilization case manager jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for utilization case manager in Brea, CA is $37.79, according to ZipRecruiter salary data. Most workers in this role earn between $30.62 and $39.86 per hour, depending on experience, location, and employer.

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.

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.

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 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 degree do I need for utilization case manager?

Utilization case managers typically need at least a bachelor's degree in healthcare, social work, nursing, or a related field. Some positions may prefer or require a master's degree or relevant certifications, such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ).

What job categories do people searching Utilization Case Manager jobs in Brea, CA look for?

The top searched job categories for Utilization Case Manager jobs in Brea, CA are:

What cities near Brea, CA are hiring for Utilization Case Manager jobs?

Cities near Brea, CA with the most Utilization Case Manager job openings:

Utilization Case Manager jobs near you
Infographic showing various Utilization Case Manager job openings in Brea, CA as of August 2026, with employment types broken down into 1% Internship, 85% Full Time, 11% Part Time, and 3% Contract. Highlights an 79% Physical, 3% Hybrid, and 18% Remote job distribution, with an average salary of $78,612 per year, or $37.8 per hour.

Utilization Review Case Manager - PT Days

Torrance Memorial Medical Center

Torrance, CA • On-site

$56.39 - $87.25/hr

Part-time

Posted 9 days ago

Torrance Memorial Medical Center rating

7.8

Company rating: 7.8 out of 10

Based on 41 frontline employees who took The Breakroom Quiz

198th of 1,065 rated hospitals

Job description

Description
Under general supervision, performs review of patient charts as required by the Hospitals Utilization Management Review Plan. The Utilization Review Case Manager (UR CM) validates the patient's placement to be at the most appropriate level of care based on nationally accepted admission criteria. The UR CM uses medical necessity screening tools, such as InterQual or MCG criteria, to complete initial (if not complete) and continued stay reviews in determining appropriate levels of patient care. The UR CM secures authorization for the patient's clinical services through collaboration and communication with the payers as required. The UR CM follows the UR process as defined in the Utilization Review Plan in accordance with the CMS condition of Participation for Utilization Review.Core Competencies
  • Anticipates and assesses and informs payers of patient's discharge planning needs.
  • Assesses need for home durable equipment, follows-up with home health and include(s) anticipated need in communication with payers
  • Assists and supports a new or transferred employee through a planned orientation.
  • Assists with the orientation and competency assessment of staff.
  • Attends denial management committee.
  • Collaborates with interdisciplinary and communicates this plan to the payer
  • Collaborates with RN Case Managers and the Physician Advisors to facilitate the peer to peer process in order to mitigate potential denials
  • Collaborates/communicates with external case managers.
  • Communicates with the patient, family, medical staff and others during the continuum of care
  • Completes all documentation in a clear, clean, concise manner.
  • Complies with all applicable laws and regulations.
  • Complies with organizational quality dashboard/benchmarking goals
  • Complies with Joint Commission's national patient safety goals
  • Demonstrates culturally competent patient care.
  • Demonstrates good customer relations skills.
  • Demonstrates independent judgment, autonomy, initiative, time management and organizational skills and the ability to prioritize projects/functions in a busy work environment.
  • Demonstrates knowledge of clinical norms for the different age groups as applicable to job functions.
  • Develops and maintains cooperative relationships with hospital personnel, physicians, suppliers and insurance case managers.
  • Demonstrates interpersonal communication skills that enable exchange of ideas and information effective with patients, families, and colleagues of all levels
  • Documents daily using MCG criteria.
  • Ensures optimal customer service/patient experience by role modeling excellent customer service
  • Ensures the physician writes an order to admit the patient to appropriate level of care along with nursing, verify the physician writes a valid patient status order.
  • Evaluates and makes positive suggestions for change in the environment.
  • Follows up with a phone call in order to answer questions, problem solve.
  • Facilitates transfer to other facilities.
  • Follows up with Medi-Cal TAR submission during the patients stay according to the DHS requirement.
  • Gives initial review and updates to insurance provider.
  • Identifies and monitors Observation cases on a daily basis.
  • Identifies and resolves delays and obstacles in collaboration with the RN Case Managers, nursing and the attending physicians
  • Identifies inappropriate bed utilization and quality of care problems and refers them to Utilization Management physician advisor.
  • Maintains Blue Cross Hold under 2 million dollars daily.
  • Maintains working knowledge of Medicare requirements for patient status (Two-Midnight Rule, Inpatient Only List)
  • Performs chart reviews and quality assessments on all patients using MCG criteria and secondary review as directed by Administration and the Medical Staff or as per contract or payer expectation (UR Committee).
  • Performs retrospective reviews.
  • Provides documentation for denial letter, collaborates with RN case manager for the delivery of denial letters to patients.
  • Researches denial claims and submits additional clinical for reconsideration when appropriate, or refers to physician advisor for recommendation
  • Reviews all commercial accounts daily or as per contract or payer expectation
  • Tracks avoidable days.

Education
DegreeProgramBachelorsNursing
Experience
Number of Years ExperienceType of Experience1Acute hospital case management, Health Plan Utilization Review2Clinical experience in an acute care facilityLicense / Certification Requirements
Registered Nurse License
Compensation Range:
$56.39 - 87.25 / Hour

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