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Utilization Management Jobs in Riverside, CA (NOW HIRING)

KPC Global MSO

Utilization Review LVN

Santa Ana, CA · On-site

Utilization Review LVN SUMMARY The purpose of the Utilization Management LVN is to ensure quality of patient care, effective utilization of available health services, review of admissions for medical ...

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Utilization Management information

See Riverside, CA salary details

$40.7K

$93.4K

$170.1K

How much do utilization management jobs pay per year?

As of Sep 8, 2026, the average yearly pay for utilization management in Riverside, CA is $93,354.00, according to ZipRecruiter salary data. Most workers in this role earn between $67,300.00 and $109,000.00 per year, depending on experience, location, and employer.

What is utilization management?

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.

What are the typical daily responsibilities of a utilization management professional?

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.

What are the key skills and qualifications needed to thrive in utilization management, and why are they important?

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.

What degree is needed for utilization management?

Utilization management professionals typically need at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Some roles may require a master's degree or professional certifications such as Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM). Experience in healthcare settings and knowledge of medical terminology and insurance processes are also important.

What are the most commonly searched types of Utilization Management jobs in Riverside, CA?

The most popular types of Utilization Management jobs in Riverside, CA are:

What are popular job titles related to Utilization Management jobs in Riverside, CA?

For Utilization Management jobs in Riverside, CA, the most frequently searched job titles are:

What job categories do people searching Utilization Management jobs in Riverside, CA look for?

The top searched job categories for Utilization Management jobs in Riverside, CA are:

What cities near Riverside, CA are hiring for Utilization Management jobs?

Cities near Riverside, CA with the most Utilization Management job openings:

Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Riverside, CA as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 19% Part Time, and 2% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $93,354 per year, or $44.9 per hour.

On-Call Inpatient Care Manager LVN

LSMA Management Inc

San Bernardino, CA • On-site

$34 - $37/hr

Full-time

Re-posted 2 days ago

Job description

JOB SUMMARY
The On-Call Inpatient Care Manager Licensed Vocational Nurse (LVN) is a California-licensed vocational nurse responsible for providing after-hours medical management support under the direction of a Registered Nurse, Medical Director, or other authorized clinical leadership. 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 and compliance with applicable regulatory, accreditation, and health plan requirements.
Requirements
MINIMUM & PREFERRED QUALIFICATIONS
Education/Training
Minimum: High School diploma or equivalent required. Graduated from an accredited Licensed Vocational Nursing program.
Preferred: Additional training or coursework in utilization management, care coordination, or managed care operations.
Experience
Minimum: Six months to one year of clinical experience as an LVN.
Preferred: Experience in utilization management support, case management assistance, discharge planning, MSO, IPA, or health plan environments.
Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.
Certification(s)
Current, active, unrestricted California LVN license.
Skills, Knowledge & Abilities
• Understanding of utilization management processes and medical necessity documentation requirements appropriate to LVN scope of practice.
• Familiarity with medical terminology and basic ICD-10, CPT, and HCPCS coding concepts.
• Ability to follow clinical protocols, guidelines, and escalation pathways.
• Strong organizational, time management, and documentation skills.
• Effective verbal and written communication skills.
• Ability to prioritize tasks and respond effectively during on-call hours under supervision.
• Proficiency with electronic medical records, utilization management systems, and Microsoft Office applications.
PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS
The physical, mental, and environmental demands described below are representative of those required to perform the essential functions of this position, with or without reasonable accommodation. The role involves primarily sedentary work with extended periods of sitting, screen time, typing, and telephone use, along with occasional standing, walking, bending, and lifting of materials up to 20 pounds. The position requires sustained attention to accurately process clinical information and follow established protocols during on-call hours, as well as the ability to work evenings, nights, weekends, and holidays in accordance with assigned on-call schedules.
PAY RANGE
$34.00 - $37.00 / hourly
Salary Description
$34.00 - $37.00 / hourly

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