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Utilization Coordinator Jobs in Riverside, CA (NOW HIRING)

KPC Health

Utilization Review Tech

Santa Ana, CA · On-site

Utilization Review Technician Under direction of the Utilization Review Technician Supervisor, the Utilization Review Technician coordinates with the Utilization Management Department while being ...

KPC Global MSO

Utilization Review Tech

Santa Ana, CA · On-site

SUMMARY Under direction of the Utilization Review Technician Supervisor, the Utilization Review Technician coordinates with the Utilization Management Department while being responsible for ...

Medix

Utilization Review Nurse

Orange, CA · On-site

$38 - $53/hr

... coordinating care for DME, Home Health, and Skilled Nursing Facility (SNF) placements ... Manage the beginning-to-end Utilization Management (UM) process through Discharge Planning.

Inland Respite Inc.

Utilization Clerk

Corona, CA · On-site

$23 - $26/hr

Utilization Clerk (Bilingual - Spanish Required) Location: Corona, California Schedule: Full-Time ... Care Coordination Our Mission At Inland Respite , we provide high-quality, compassionate respite ...

INL Corona

Care Coordinator

Corona, CA · On-site

$19.75 - $26.75/hr

Care Coordinator (Bilingual Spanish Required) Location: Corona, California Schedule: Full-Time ... Your role ensures accuracy in timekeeping, supports utilization monitoring, and provides technical ...

INL Corona

Care Coordinator

Corona, CA · On-site

$23 - $26/hr

Care Coordinator (Bilingual Spanish Required) Location: Corona, California Schedule: Full-Time ... Your role ensures accuracy in timekeeping, supports utilization monitoring, and provides technical ...

Prime Healthcare

Utilization Review Nurse LVN

Ontario, CA · On-site

$71K - $99K/yr

Responsibilities Responsible for the daily coordination and oversight to the Referral Technicians ... Utilization Management experience required. * Excellent interpersonal relationship skills with ...

INL Corona

Care Coordinator

Corona, CA · On-site

$19.75 - $26.75/hr

Care Coordinator (Bilingual Spanish Required) Location: Corona, California Schedule: Full-Time ... Your role ensures accuracy in timekeeping, supports utilization monitoring, and provides technical ...

INL Corona

Care Coordinator

Corona, CA · On-site

$19.75 - $26.75/hr

Care Coordinator(Bilingual Spanish Required) Location: Corona, California Schedule: Full-Time ... Your role ensures accuracy in timekeeping, supports utilization monitoring, and provides technical ...

INL Corona

Senior Care Coordinator

Corona, CA · On-site

This position provides leadership and operational support to Care Coordinators (CCs) and Utilization Clerks (UCs), manages escalated consumer and provider concerns, and promotes consistent adherence ...

Dungarvin

Staffing Coordinator

Menifee, CA · On-site

$23.50/hr

Scheduling & Service Utilization Monitoring: Monitor caregiver schedules, authorized service hours ... Scheduling & Coordination Experience: 2+ years of experience in staffing, scheduling, service ...

Dungarvin

Staffing Coordinator

Menifee, CA · On-site

$23.50/hr

Scheduling & Service Utilization Monitoring: Monitor caregiver schedules, authorized service hours ... Scheduling & Coordination Experience: 2+ years of experience in staffing, scheduling, service ...

Dungarvin

Staffing Coordinator

Menifee, CA · On-site

$23.50/hr

Scheduling & Service Utilization Monitoring: Monitor caregiver schedules, authorized service hours ... Scheduling & Coordination Experience: 2+ years of experience in staffing, scheduling, service ...

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All JobsUtilization JobsUtilization Coordinator JobsUtilization Coordinator Jobs in Riverside, CA

Utilization Coordinator information

See Riverside, CA salary details

$16

$28

$58

How much do utilization coordinator jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for utilization coordinator in Riverside, CA is $28.81, according to ZipRecruiter salary data. Most workers in this role earn between $20.34 and $32.60 per hour, depending on experience, location, and employer.

How does a utilization coordinator typically interact with clinical and administrative teams in a healthcare setting?

A Utilization Coordinator regularly collaborates with both clinical teams, such as physicians and nurses, and administrative staff to ensure that patient care services are medically necessary and efficiently delivered. They review medical records, coordinate pre-authorizations, and communicate with insurance providers to support appropriate resource use. Effective communication and teamwork are essential, as Utilization Coordinators often serve as a liaison between departments, helping to resolve discrepancies and streamline processes for optimal patient outcomes.

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

To thrive as a Utilization Coordinator, you need a background in healthcare or social services, strong analytical skills, and familiarity with medical terminology, often supported by a relevant degree or certification. Proficiency in case management software, electronic health records (EHRs), and knowledge of insurance policies and regulatory requirements is typically required. Excellent communication, organizational, and problem-solving abilities help you effectively coordinate care and advocate for patient needs. These skills ensure efficient resource utilization, regulatory compliance, and optimal patient outcomes within healthcare organizations.

What is the difference between Utilization Coordinator vs Utilization Review Specialist?

AspectUtilization CoordinatorUtilization Review Specialist
CredentialsTypically requires healthcare-related certifications or licenses, such as a Registered Nurse (RN) or healthcare administration backgroundOften requires similar healthcare credentials, including RN, licensed practical nurse (LPN), or medical reviewer certifications
Work EnvironmentWorks in hospitals, clinics, or insurance companies, coordinating patient services and resource allocationWorks mainly in insurance companies or healthcare facilities, reviewing medical necessity and treatment plans
Employer & Industry UsageCommonly employed by healthcare providers and insurance companies to optimize resource usePrimarily employed by insurance companies and third-party payers for case reviews

While both roles involve healthcare coordination and require similar credentials, the Utilization Coordinator focuses on managing patient services and resource allocation, whereas the Utilization Review Specialist primarily reviews medical necessity and treatment plans for approval or denial.

What degree do I need for utilization review?

Utilization coordinators typically need at least a bachelor's degree in healthcare administration, nursing, or a related field. Relevant certifications, such as the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects. Strong knowledge of medical terminology, insurance processes, and data management tools is also important.

What is a utilization coordinator?

Utilization Coordinators are healthcare professionals responsible for reviewing and monitoring the use of medical services to ensure patients receive appropriate care efficiently and cost-effectively. They assess treatment plans, review medical records, and help coordinate care among providers to ensure compliance with insurance and regulatory guidelines. Utilization Coordinators also work with clinical staff to determine the medical necessity of procedures and help optimize patient outcomes while managing healthcare costs.
What are the most commonly searched types of Utilization jobs in Riverside, CA? The most popular types of Utilization jobs in Riverside, CA are:
What cities near Riverside, CA are hiring for Utilization Coordinator jobs? Cities near Riverside, CA with the most Utilization Coordinator job openings:
Utilization Coordinator jobs near you
Infographic showing various Utilization Coordinator job openings in Riverside, CA as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 16% Part Time, 1% Temporary, and 3% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $59,934 per year, or $28.8 per hour.

Utilization Review Tech

KPC Health

Santa Ana, CA • On-site

Other

Posted 9 days ago

Job description

Utilization Review Technician

Under direction of the Utilization Review Technician Supervisor, the Utilization Review Technician coordinates with the Utilization Management Department while being responsible for coordinating phone calls, clinical requests, upkeeps data entry, organizes denials and mailing/faxing appeals, tracking data from various insurance providers and health plans regarding authorization and/or denials, expedite reviews and documentation to insurance providers. Monitors patient charts and records to provide to responsible parties and request for authorization for hospital admission. Reviews treatment plans and status of approvals from insurers. Collects and compiles data as required and according to applicable policies and regulations. Performs administrative duties for the Utilization Management Department, and directed in several aspects of duties. Position is non-RN/LVN.

Requirements
  • Ability to establish and maintain effective working relationships across the Health System
  • Ability to interpret and understand various medical insurance plans and make accurate determinations regarding coverage
  • Follow up with insurance companies regarding the status of outstanding claims and necessary steps for resolution
  • Answer and review pertinent insurance correspondence to ensure complete and accurate reimbursement for medical claims
  • Responsible for working payer correspondence, edits and aged account receivable, and identifying and correcting billing errors
  • Pull daily reports utilizing Microsoft Excel and providing correct correspondence to payer
  • Research payer rules and regulations to maintain current payer knowledge
  • Comply with HIPAA and other compliance requirements to protect patient confidentiality
  • Manage data in internal and external databases with accuracy
  • Provide high-level administrative support and assistance to the Director and Supervisor or other assigned leadership staff
  • Perform clerical and administrative tasks including drafting letters, memos, invoices, reports, and other documents for senior staff
  • Prepare patient charts for medical audits
Education & Experience Requirements:
  • High School Diploma
  • Healthcare experience strongly preferred
Skills & Abilities Requirements:
  • Excellent verbal and written communication skills
  • Excellent organizational skills and attention to detail
  • Excellent time management skills with a proven ability to meet deadlines
  • Ability to function well in a high-paced and at times stressful environment
  • Extensive knowledge of office administration, clerical procedures, and recordkeeping systems
  • Able to type minimum of 50 words per minute
  • Knowledge of CMS, State Regulations, URAC and NCQA guidelines preferred.
  • ICD-10 and CPT coding experience a plus
  • Experienced computer skills with Microsoft Word, Microsoft Outlook, Excel and experience working in a health plan medical management documentation system a plus
  • Extremely proficient with Microsoft Office Suite or similar software with the ability to learn new or updated software
  • Medical Terminology preferred
Physical Requirements:
  • Body Positions: Sitting and standing for prolonged periods.
  • Body Movements: Arm and hand dexterity.
  • Body Senses: Must have command of close and distant sight, color perception and hearing.
  • Strength: Ability to lift and move up to 25-pounds.
Working Environment:
  • Work in an office, where the climate is controlled.
  • OSHA exposure category: II
  • Category I – Position includes tasks that involve exposure to Blood borne Pathogens.
  • Category II – Position includes tasks that do not have exposure to Bloodborne Pathogens, however employment may require unplanned Category I tasks.
  • Category III – Positions includes tasks that do not involve exposure to Bloodborne Pathogens. This position would not be required to perform Category I tasks.
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About KPC Health

Sourced by ZipRecruiter

KPC Health has an integrated approach to serving the people of Riverside, San Bernardino and Orange County. Our acute care medical centers provide high quality, comprehensive and affordable healthcare for the entire family. For us, healthcare is not just about caring for our patients, but also about investing in the people throughout our communities. We are one team with one mission and that mission is for all our patients, and their families to Enjoy Life in Great Health.

Industry

Health care and social assistance

Company size

201 - 500 Employees

Headquarters location

Santa Ana, CA, US

Year founded

2004

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