Orange, CA · On-site
$37.43 - $50/hr
LVN Prior Authorization Nurse / Case Manager HealthCare Support is actively seeking a LVN Prior Authorization Nurse / Case Manager to fill an opening in Orange , California . Daily Responsibilities ...
New
Orange, CA · On-site
$37.43 - $50/hr
LVN Prior Authorization Nurse / Case Manager HealthCare Support is actively seeking a LVN Prior Authorization Nurse / Case Manager to fill an opening in Orange , California . Daily Responsibilities ...
New
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
$49.98 - $72.47/hr
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. The Care Manager is accountable for a designated patient caseload and plans effectively ...
$49.98 - $72.47/hr
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. The Care Manager is accountable for a designated patient caseload and plans effectively ...
Supervise Utilization Management Nurses and Coordinators, including conducting timely performance evaluations, addressing performance issues, and identifying training needs. * Escalate operational ...
Supervise Utilization Management Nurses and Coordinators, including conducting timely performance evaluations, addressing performance issues, and identifying training needs. * Escalate operational ...
Orange, CA · On-site
Utilization Management Authorization Review Nurse Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering ...
Orange, CA · On-site
Utilization Management Authorization Review Nurse Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering ...
Redlands, CA · On-site
$49.98 - $72.47/hr
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. The Care Manager is accountable for a designated patient caseload and plans effectively ...
Redlands, CA · On-site
$49.98 - $72.47/hr
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. The Care Manager is accountable for a designated patient caseload and plans effectively ...
Redlands, CA · On-site
$49.98 - $72.47/hr
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. The Care Manager is accountable for a designated patient caseload and plans effectively ...
Redlands, CA · On-site
$49.98 - $72.47/hr
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. The Care Manager is accountable for a designated patient caseload and plans effectively ...
Redlands, CA · On-site
$65/hr
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. The Care Manager is accountable for a designated patient caseload and plans effectively ...
Redlands, CA · On-site
$65/hr
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. The Care Manager is accountable for a designated patient caseload and plans effectively ...
Santa Ana, CA · On-site
Actively participates in Case Management and Treatment Team meetings * Serves as on-going educator ... Utilization Review and Case Management reporting * Able to work independently and use sound ...
Santa Ana, CA · On-site
Actively participates in Case Management and Treatment Team meetings * Serves as on-going educator ... Utilization Review and Case Management reporting * Able to work independently and use sound ...
Santa Ana, CA · On-site
Actively participates in Case Management and Treatment Team meetings * Serves as on-going educator ... Utilization Review and Case Management reporting * Able to work independently and use sound ...
New
Santa Ana, CA · On-site
Actively participates in Case Management and Treatment Team meetings * Serves as on-going educator ... Utilization Review and Case Management reporting * Able to work independently and use sound ...
New
Santa Ana, CA · On-site
$50 - $85/hr
Actively participates in Case Management and Treatment Team meetings * Serves as on-going educator ... Utilization Review and Case Management reporting * Able to work independently and use sound ...
Quick apply
Santa Ana, CA · On-site
$50 - $85/hr
Actively participates in Case Management and Treatment Team meetings * Serves as on-going educator ... Utilization Review and Case Management reporting * Able to work independently and use sound ...
Orange, CA · On-site
The Utilization Management Authorization Review Nurse is responsible for managing inpatient & outpatient utilization by conducting thorough reviews of clinical documentation and applying clinical ...
Orange, CA · On-site
The Utilization Management Authorization Review Nurse is responsible for managing inpatient & outpatient utilization by conducting thorough reviews of clinical documentation and applying clinical ...
$31 - $50/hr
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Act as liaison between managed care organizations and the facility professional clinical staff.
$31 - $50/hr
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Act as liaison between managed care organizations and the facility professional clinical staff.
Orange, CA · On-site
$38 - $51/hr
Remote Utilization Management Nurse - RN/LVN Location: 100% Remote Schedule: Monday-Friday, 8:00 AM-5:00 PM PST Pay: $40-$51/hour, depending on experience and licensure Position Overview We are ...
Orange, CA · On-site
$38 - $51/hr
Remote Utilization Management Nurse - RN/LVN Location: 100% Remote Schedule: Monday-Friday, 8:00 AM-5:00 PM PST Pay: $40-$51/hour, depending on experience and licensure Position Overview We are ...
Santa Ana, CA · On-site
$80 - $100/hr
Actively participates in Case Management and Treatment Team meetings * Serves as on-going educator ... Utilization Review and Case Management reporting * Able to work independently and use sound ...
Santa Ana, CA · On-site
$80 - $100/hr
Actively participates in Case Management and Treatment Team meetings * Serves as on-going educator ... Utilization Review and Case Management reporting * Able to work independently and use sound ...
$31 - $50/hr
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Act as liaison between managed care organizations and the facility professional clinical staff.
$31 - $50/hr
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Act as liaison between managed care organizations and the facility professional clinical staff.
Riverside, CA · On-site
$31 - $50/hr
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Act as liaison between managed care organizations and the facility professional clinical staff.
Riverside, CA · On-site
$31 - $50/hr
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Act as liaison between managed care organizations and the facility professional clinical staff.
San Bernardino, CA · On-site
$34 - $37/hr
The role supports utilization management (UM), care coordination, discharge processing, and urgent authorization facilitation when the Medical Management office is closed, ensuring continuity of care ...
San Bernardino, CA · On-site
$34 - $37/hr
The role supports utilization management (UM), care coordination, discharge processing, and urgent authorization facilitation when the Medical Management office is closed, ensuring continuity of care ...
San Bernardino, CA · On-site
$34 - $37/hr
The role supports utilization management (UM), care coordination, discharge processing, and urgent authorization facilitation when the Medical Management office is closed, ensuring continuity of care ...
San Bernardino, CA · On-site
$34 - $37/hr
The role supports utilization management (UM), care coordination, discharge processing, and urgent authorization facilitation when the Medical Management office is closed, ensuring continuity of care ...
San Bernardino, CA · On-site
$34 - $37/hr
The role supports utilization management (UM), care coordination, discharge processing, and urgent authorization facilitation when the Medical Management office is closed, ensuring continuity of care ...
San Bernardino, CA · On-site
$34 - $37/hr
The role supports utilization management (UM), care coordination, discharge processing, and urgent authorization facilitation when the Medical Management office is closed, ensuring continuity of care ...
$40.7K - $52.4K
15% of jobs
$52.4K - $64.2K
8% of jobs
$65.9K is the 25th percentile. Wages below this are outliers.
$64.2K - $76K
15% of jobs
The median wage is $83.4K / yr.
$76K - $87.7K
20% of jobs
$87.7K - $99.5K
11% of jobs
$105.4K is the 75th percentile. Wages above this are outliers.
$99.5K - $111.3K
13% of jobs
$111.3K - $123K
5% of jobs
$123K - $134.8K
3% of jobs
$134.8K - $146.5K
4% of jobs
$146.5K - $158.3K
3% of jobs
$158.3K - $170.1K
3% of jobs
$40.7K
$93.4K
$170.1K
A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.
As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.
To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.
The most popular types of Utilization Management jobs in Riverside, CA are:
For Utilization Management jobs in Riverside, CA, the most frequently searched job titles are:
The top searched job categories for Utilization Management jobs in Riverside, CA are:
Cities near Riverside, CA with the most Utilization Management job openings:
$37.43 - $50/hr
Other
Dental, Life
Posted 3 days ago
New
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HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.
Recruiting and staffing services
201 - 500 Employees
Maitland, FL, US
2003
