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Utilization Management Non Clinical Jobs in California

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Utilization Management Non Clinical information

What is the difference between Utilization Management Non Clinical vs Utilization Review Nurse?

AspectUtilization Management Non ClinicalUtilization Review Nurse
CredentialsCertifications like CCM, RN (optional), but primarily non-clinical certificationsRN license, certifications such as CCM or CUC
Work EnvironmentOffice-based, administrative setting, telecommuting optionsClinical settings, hospitals, or insurance companies, often with direct patient or provider interaction
Employer & Industry UsageHealth insurance companies, managed care organizationsHospitals, insurance companies, healthcare providers
Search & Comparison IntentUnderstanding non-clinical roles in utilization managementClinical review roles involving direct patient care assessment

Utilization Management Non Clinical roles focus on administrative, policy, and documentation tasks without direct patient care, while Utilization Review Nurses perform clinical assessments to determine care necessity. Both roles are essential in healthcare utilization but differ mainly in clinical involvement and required credentials.

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For Utilization Management Non Clinical jobs in California, the most frequently searched job titles are:

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Cities in California with the most Utilization Management Non Clinical job openings:

Utilization Management Non Clinical jobs near you
Infographic showing various Utilization Management Non Clinical job openings in California as of August 2026, with employment types broken down into 100% Full Time. Highlights an 90% In-person, and 10% Remote job distribution.

Utilization Management Clinical

Butte Home Health & Hospice

Chico, CA • On-site

$50 - $60/hr

Other

Re-posted 5 days ago

Job description

Utilization Management Clinical

Office - Chico, CA 95973

Overview

Salary Range $50.00 - $60.00 Hourly Position Type Full Time Job Shift Day Education Level Professional License Required Category Health Care

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.
Qualifications

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.

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