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Utilization Management Jobs in Santa Rosa, CA (NOW HIRING)

Serenity Knolls

Utilization Specialist

Forest Knolls, CA · On-site

$33 - $38/hr

Experience as a Utilization Review Specialist/Management is a requirement for this position. * Previous experience with Insurance and Optimization of Services is essential for this role. * Past ...

Alignment Health

Internal Medicine Physician

Novato, CA · Remote

MUST HAVE CALIFORNIA LICENSE Utilization Management Experience The Utilization Management, Medical Director works with Senior Medical Officers, Regional Medical Officers, Extensivists, the Healthcare ...

Prime Staffing

Travel RN Case Manager

Santa Rosa, CA · On-site

Supports utilization management and ensures compliance with payer guidelines. Onboarding typically takes 2-4 weeks based on documentation and clearance processes. Requirements Required for Onboarding:

Altais

Regional Medical Director / Physician

Petaluma, CA · Hybrid

$300K - $325K/yr

Oversee utilization management activities, review and approve medical necessity for treatments, and facilitate clinical rounds with case managers. * Foster strong relationships with network ...

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Utilization Management information

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$42.6K

$97.8K

$178.2K

How much do utilization management jobs pay per year?

As of Jun 7, 2026, the average yearly pay for utilization management in Santa Rosa, CA is $97,834.00, according to ZipRecruiter salary data. Most workers in this role earn between $70,500.00 and $114,300.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Utilization Management position, 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 a Utilization Management job?

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 popular job titles related to Utilization Management jobs in Santa Rosa, CA? For Utilization Management jobs in Santa Rosa, CA, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in Santa Rosa, CA look for? The top searched job categories for Utilization Management jobs in Santa Rosa, CA are:
What cities near Santa Rosa, CA are hiring for Utilization Management jobs? Cities near Santa Rosa, CA with the most Utilization Management job openings:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Santa Rosa, CA as of May 2026, with employment types broken down into 1% As Needed, 88% Full Time, and 11% Part Time. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $97,834 per year, or $47 per hour.

Utilization Specialist

Serenity Knolls

Forest Knolls, CA • On-site

$33 - $38/hr

Full-time

Posted 27 days ago

Job description

Overview

Serenity Knolls is seeking a Full Time On-Site Utilization Review Specialist at our substance use facility. 

Proactively monitor utilization of services for patients to optimize reimbursement for the facility.  

  • Experience as a Utilization Review Specialist/Management is a requirement for this position.
  • Previous experience with Insurance and Optimization of Services is essential for this role.
  • Past experience in insurance claims and processing helpful.

Hourly pay rate: $33.00-$38.00

Serenity Knolls is located in the beautiful San Geronimo Valley just 10 minutes West of Fairfax. This is an on-site position at our facility.

Serenity Knolls is a 42 bed co-ed facility serving ages 18 and up. Included in the 42 bed capacity are 6 beds available for detox. Serenity Knolls is a 12 step based, social model residential treatment center. The Knolls uniquely combines the traditional social model of care with contemporary cognitive behavioral, psychodynamic and evidence based practice.

We are committed to fostering a diverse and inclusive workplace that reflects the communities we serve. We are an Equal Opportunity Employer and do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, veteran status, or any other protected status under applicable law.

Responsibilities

ESSENTIAL FUNCTIONS: 

  • Act as liaison between managed care organizations and the facility professional clinical staff. 
  • Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements. 
  • Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.  
  • Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office. 
  • Conduct quality reviews for medical necessity and services provided.   
  • Facilitate peer review calls between facility and external organizations.  
  • Initiate and complete the formal appeal process for denied admissions or continued stay.  
  • Assist the admissions department with pre-certifications of care.  
  • Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates. 

OTHER FUNCTIONS:  

  • Perform other functions and tasks as assigned. 
Qualifications

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: 

  • Required Education: High school diploma or equivalent. 
  • Preferred Education: Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field. 
  • Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred 

LICENSES/DESIGNATIONS/CERTIFICATIONS:  

  • Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services. 
  • CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.   
  • First aid may be required based on state or facility requirements. 

 

ADDITIONAL REGULATORY REQUIREMENTS: 

While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances  (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate. 

We are committed to providing equal  employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.

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Employment Type: FULL_TIME

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