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Utilization Management Jobs in Riverside, CA (NOW HIRING)

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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 Aug 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 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 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 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 July 2026, with employment types broken down into 88% Full Time, 6% Part Time, and 6% Contract. Highlights an 94% In-person, and 6% Remote job distribution, with an average salary of $93,354 per year, or $44.9 per hour.

Prior Authorization LVN

LSMA Management Inc

San Bernardino, CA • On-site

$35 - $40/hr

Full-time

Posted 17 days ago

Job description

Description:

JOB SUMMARY:

The Prior Authorization Nurse (LVN) is responsible for performing clinical review and evaluation of authorization requests to ensure medical necessity, appropriate utilization of healthcare services, and compliance with regulatory and health plan requirements. This role conducts prospective, concurrent, and retrospective review of medical services including specialty care, diagnostic procedures, elective admissions, post-acute services, and out-of-network referrals. The Prior Authorization LVN collaborates with providers, health plans, and internal clinical teams to support timely care coordination while ensuring adherence to CMS, NCQA, and organizational guidelines. The position serves as a clinical resource to Prior Authorization Coordinators and supports efficient utilization management operations.

Requirements:

MINIMUM & PREFERRED QUALIFICATIONS:


Education/Training

Minimum: High School diploma or equivalent required. Graduate from an accredited Vocational Nursing Program.


Experience

Minimum: At least one year of clinical experience in a healthcare setting. Basic knowledge of medical terminology, utilization management processes, and clinical care practices.

Preferred: Two or more years of utilization management, prior authorization, case management, or managed care experience. Experience working in an MSO, IPA, health plan, or medical group environment. Experience using Milliman Care Guidelines (MCG), InterQual, or similar criteria tools. Knowledge of ICD-10, CPT, and HCPCS coding. Experience with electronic health record and utilization management systems.

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 required.

Skills, Knowledge & Abilities

· Knowledge of utilization management principles, medical necessity criteria, and managed care processes.

· Understanding of clinical documentation and healthcare delivery systems.

· Familiarity with regulatory requirements including NCQA, CMS, and HIPAA.

· Strong verbal and written communication skills.

· Ability to effectively communicate with physicians, providers, and interdisciplinary teams.

· Ability to provide clear and professional clinical guidance.

· Ability to review and interpret clinical information and apply established criteria.

· Strong organizational and prioritization skills.

· Ability to manage multiple tasks and deadlines efficiently.

· Proficiency in Microsoft Office (Word, Excel, Outlook).

· Ability to use electronic medical records and authorization systems.

· Ability to learn and adapt to new software and technology.

· Strong attention to detail and accuracy.

· Ability to maintain confidentiality and professionalism.

· Ability to work independently and as part of a team.

· Ability to review and interpret clinical information and apply established criteria.

· Strong organizational and prioritization skills.

· Ability to manage multiple tasks and deadlines efficiently.

· Proficiency in Microsoft Office (Word, Excel, Outlook).

· Ability to use electronic medical records and authorization systems.

· Ability to learn and adapt to new software and technology.

· Strong attention to detail and accuracy.

· Ability to maintain confidentiality and professionalism.

· Ability to work independently and as part of a team.


PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS:

The physical demands described here are represented of those that must be met by an employee to successfully perform the essential functions of this job. Prolonged sitting, typing, and computer work. Occasional standing, walking, bending, and reaching. Ability to lift up to 20 pounds occasionally. Ability to concentrate for extended periods while reviewing clinical documentation. Ability to manage multiple priorities in a fast-paced environment. Ability to exercise sound clinical judgment and decision-making. Frequent interaction with healthcare providers and internal staff via phone and electronic communication. Low to moderate noise level consistent with office environment.


PAY RANGE

$35.00 - $40.00 / hourly

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