ZipRecruiter

Log In

1

Utilization Management Case Manager Rn Jobs in California

TotalMed RN

Travel Utilization Review RN

Irvine, CA · On-site

TotalMed RN is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Irvine, California. & Requirements * Specialty: Utilization Review * Discipline: RN * Duration ...

TotalMed RN

Travel Utilization Review RN

Escondido, CA · On-site

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

next page

Showing results 1-20

All JobsUtilization Management Case Rn JobsUtilization Management Case Manager Rn JobsUtilization Management Case Manager Rn Jobs in California

Utilization Management Case Manager Rn information

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

AspectUtilization Management Case Manager RnUtilization Review Nurse
CredentialsRN license, certification in case management (e.g., CCM)RN license, often with certification in utilization review
Work EnvironmentInsurance companies, healthcare facilities, case management teamsHospitals, insurance companies, outpatient clinics
Primary FocusCoordinating patient care, managing cases, ensuring appropriate utilizationReviewing medical necessity, approving or denying services
Common TasksAssessing patient needs, developing care plans, liaising with providersEvaluating medical records, making utilization decisions, ensuring compliance

The main difference is that the Utilization Management Case Manager Rn focuses on coordinating patient care and managing cases, while the Utilization Review Nurse primarily reviews medical records to approve or deny services. Both roles require RN licensure and related certifications, but their daily responsibilities and work environments differ slightly.

Are utilization management case managers in demand?

Utilization management case managers are in demand due to the growing need for healthcare cost control and efficient patient care coordination. Employers in healthcare organizations, insurance companies, and managed care plans seek professionals with strong clinical knowledge, certification, and experience in utilization review processes. The role offers stable employment opportunities as healthcare systems focus on cost-effective treatment management.

What cities in California are hiring for Utilization Management Case Manager Rn jobs?

Cities in California with the most Utilization Management Case Manager Rn job openings:

Infographic showing various Utilization Management Case Manager Rn job openings in California as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 17% Part Time, and 4% Contract. Highlights an 82% Physical, 3% Hybrid, and 15% Remote job distribution.

Utilization Management Clinical

Chico, CA • On-site

BUTTE HOME HEALTH INC
Home Health Care Services • 51 - 200 employees
Learn more about BUTTE HOME HEALTH INCexternal

$50 - $60/hr

Full-time

Re-posted 29 days ago

Job description

The Utilization Manager, Registered Nurse, is an office-based nursing position responsible for supporting high-quality patient care through clinical oversight, utilization management, and real-time guidance to field clinicians. This role serves as a key clinical resource within the organization, assisting with nursing calls, care coordination, and clinical decision-making to promote positive patient outcomes while ensuring regulatory and payer compliance.
Key responsibilities include:
  • Provide clinical support and guidance to field clinicians, including RNs, LVNs, and therapy staff.
  • Take and triage nursing calls from clinicians, patients, and caregivers as appropriate.
  • Collaborate with field staff to assist with clinical problem-solving, patient status changes, and care planning.
  • Review plans of care and clinical documentation to ensure appropriate utilization of services and skilled need.
  • Monitor visit frequencies and service utilization in alignment with physician orders, payer guidelines, and agency standards.
  • Support case managers with recertifications, discharges, transitions of care, and care coordination.
  • Participate in interdisciplinary collaboration to promote continuity of care and effective communication.
  • Identify clinical risks or concerns and escalate issues appropriately.
  • Support compliance with Medicare Conditions of Participation, regulatory requirements, and agency policies.
  • Contribute to quality improvement initiatives focused on patient outcomes, documentation accuracy, and clinical best practices.

Required Qualifications
  • Active Registered Nurse (RN) license in the state of California.
  • Strong clinical assessment, critical-thinking, and decision-making skills.
  • Excellent verbal and written communication skills.
  • Ability to work collaboratively with interdisciplinary teams.
  • Proficiency with electronic medical records (EMR) systems and basic computer applications.

Preferred Qualifications
  • Experience in utilization management, case management, or clinical coordination.
  • Home Health experience preferred but not required.
  • Knowledge of Medicare home health regulations, payer guidelines, and Conditions of Participation.
  • Experience providing clinical support, education, or mentorship to field clinicians.
  • Strong organizational skills with the ability to manage multiple priorities in a fast-paced office environment.

Apply