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Utilization Manager Jobs in California (NOW HIRING)

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Utilization Manager information

See California salary details

$38.5K

$89.8K

$165.3K

How much do utilization manager jobs pay per year?

As of Aug 12, 2026, the average yearly pay for utilization manager in California is $89,819.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,700.00 and $108,100.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a utilization manager?

To thrive as a Utilization Manager, you need a solid background in healthcare management, case review, and knowledge of insurance regulations, often supported by a degree in nursing, healthcare administration, or a related field. Familiarity with utilization management software, electronic health records (EHRs), and certification such as Certified Case Manager (CCM) are typically required. Strong analytical thinking, communication, and negotiation skills help Utilization Managers effectively coordinate care and collaborate with providers. These skills ensure appropriate resource use, regulatory compliance, and optimal patient outcomes within healthcare organizations.

What are some common challenges faced by utilization managers, and how can they be addressed?

Utilization Managers often face challenges such as balancing cost containment with patient care quality, navigating complex insurance policies, and managing high caseloads. To address these, effective communication with healthcare providers and payers is essential, as is staying current with regulatory requirements and best practices. Building strong relationships within interdisciplinary teams and leveraging data analytics tools can also help Utilization Managers make informed decisions and improve workflow efficiency.

What is a utilization manager?

A utilization manager works in the insurance industry to analyze health care needs in medical cases and determine further patient care. In this career, your job duties include conducting interviews to determine what services you register for and cutting down on unnecessary costs. You may review medical records and compile documentation to improve care and report your findings. Skills in management, customer service, and health care services are vital in this career. Job experience in nursing is a benefit when applying for utilization manager positions. Additional qualifications include a bachelor’s degree and medical case management certificate.

What is the difference between Utilization Manager vs Utilization Coordinator?

AspectUtilization ManagerUtilization Coordinator
CertificationsOften requires healthcare or case management certificationsMay have similar certifications but less emphasis on management
Work EnvironmentTypically in healthcare organizations, overseeing utilization review processesSupports daily operations, assisting with case documentation and scheduling
Employer & Industry UsageCommon in healthcare, insurance, and managed care companiesFound in similar settings, often working under Utilization Managers

In summary, a Utilization Manager generally has broader responsibilities, overseeing utilization review and resource allocation, while a Utilization Coordinator focuses on supporting daily tasks and documentation. Both roles are integral in healthcare settings but differ in scope and level of responsibility.

More about Utilization Manager jobs
What are the most commonly searched types of Utilization jobs in California? The most popular types of Utilization jobs in California are:
What are popular job titles related to Utilization Manager jobs in California? For Utilization Manager jobs in California, the most frequently searched job titles are:
What job categories do people searching Utilization Manager jobs in California look for? The top searched job categories for Utilization Manager jobs in California are:
What cities in California are hiring for Utilization Manager jobs? Cities in California with the most Utilization Manager job openings:
What are popular job titles related to Utilization Manager jobs in CA? For Utilization Manager jobs in CA, the most frequently searched job titles are:
Utilization Manager jobs near you
Infographic showing various Utilization Manager job openings in California as of August 2026, with employment types broken down into 100% Full Time. Highlights an 80% In-person, and 20% Remote job distribution, with an average salary of $89,819 per year, or $43.2 per hour.

Utilization Management - RN

Bickham Services Unlimited Llc

Sunnyvale, CA • On-site

Contractor

Posted 19 days ago

Job description

Title: Utilization Management - RN

Start Date: 08/10/2026

End Date: 02/10/2027

# of Openings: 1

Position Type: Contract

Locations: Long Beach, CA

Additional Details:

-This is a 6-month contract position with a possibility of an extension

-Must have experience with Medicare Advantage.

-Must have experience with Concurrent Review, Inpatient, Utilization Management, Discharge Planning, and Transitions of Care


Description:

Our client is seeking an experienced Concurrent Review Registered Nurse (RN) to join its Utilization Management team. In this role, you will perform concurrent reviews, prior authorizations, medical necessity reviews, discharge planning, and transitions of care while collaborating with physicians, hospitals, and interdisciplinary teams to ensure members receive appropriate, cost-effective, and evidence-based care. This position is ideal for an RN with strong acute care experience and a background in managed care, utilization management, or case management.

What You Will Do:

  • Perform concurrent, prior authorization, and retrospective utilization reviews.
  • Evaluate medical necessity using InterQual, MCG, CMS, LCD/NCD, and health plan guidelines.
  • Coordinate discharge planning and transitions of care with providers and healthcare facilities.
  • Collaborate with physicians, hospital staff, specialists, and internal care management teams.
  • Request and review additional clinical documentation when necessary.
  • Escalate complex medical necessity cases to the Medical Director.
  • Educate providers on utilization management policies and review criteria.
  • Document all reviews and clinical decisions accurately within medical management systems.
  • Identify care gaps and support quality improvement initiatives.
  • Serve as a clinical resource for internal teams.

You Will Be Successful If:

  • You have strong clinical judgment and are confident making medical necessity determinations.
  • You can effectively communicate with physicians, hospitals, and multidisciplinary teams.
  • You are highly organized and able to manage multiple cases simultaneously.
  • You thrive in a fast-paced managed care environment.
  • You are comfortable navigating challenging conversations regarding levels of care.
  • You are detail-oriented and committed to delivering high-quality patient outcomes.

What You Will Bring:

  • Active Registered Nurse (RN) license with the ability to obtain licensure in multiple states.
  • Graduate of an accredited School of Nursing.
  • Minimum 4 years of clinical nursing experience.
  • Minimum 2 years of managed care or HMO experience.
  • Experience performing medical necessity reviews using evidence-based clinical guidelines.
  • Strong knowledge of: Concurrent Review, Utilization Management, Discharge Planning, Transitions of Care
  • Experience applying: InterQual, MCG, CMS Guidelines
  • Experience working with medical management software and Microsoft Office.
  • Excellent communication, critical thinking, and organizational skills.

Preferred Experience

  • Bachelor of Science in Nursing (BSN).
  • Emergency Department (ER) experience.
  • Intensive Care Unit (ICU) experience.
  • Case Management experience.
  • Utilization Management experience within a health plan or managed care organization.
  • Experience working directly with hospitals, physicians, and provider networks.

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