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Utilization Manager Jobs in Riverside, CA (NOW HIRING)

Prime Healthcare

Utilization Review RN

Ontario, CA

$71K - $104K/yr

Responsible for the quality and resource management of all authorizations and referrals with the ... Minimum 3 years RN Utilization Manager working for a Health Plan. * At least 3 years of experience ...

Pacific Grove

Utilization Specialist PRN

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.

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · Remote

$30.64 - $45.80/hr

The Utilization Review Nurse gathers demographic and clinical information on prospective ... Strong time management skills with the ability to meet designated deadlines * Excellent written and ...

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All JobsUtilization JobsUtilization Manager JobsUtilization Manager Jobs in Riverside, CA

Utilization Manager information

See Riverside, CA salary details

$40.7K

$94.9K

$174.7K

How much do utilization manager jobs pay per year?

As of Sep 3, 2026, the average yearly pay for utilization manager in Riverside, CA is $94,949.00, according to ZipRecruiter salary data. Most workers in this role earn between $62,100.00 and $114,200.00 per year, depending on experience, location, and employer.

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 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 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 Riverside, CA?

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

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

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

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

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

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

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

Utilization Manager jobs near you
Infographic showing various Utilization Manager job openings in Riverside, CA as of August 2026, with employment types broken down into 86% Full Time, 13% Part Time, and 1% Contract. Highlights an 84% Physical, 2% Hybrid, and 14% Remote job distribution, with an average salary of $94,949 per year, or $45.6 per hour.

Utilization Review RN

Prime Healthcare Management Inc

Ontario, CA • On-site

$71K - $104K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 5 days ago

Prime Healthcare rating

6.5

Company rating: 6.5 out of 10

Based on 287 frontline employees who took The Breakroom Quiz

613th of 898 rated healthcare providers

Job description

Overview
Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation's leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!
Responsibilities
Responsible for the quality and resource management of all authorizations and referrals with the Prime Healthcare Employee EPO. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive review of the medical record for the medical necessity, intensity of service and severity of illness.
Qualifications
EDUCATION, EXPERIENCE, TRAINING
Required qualifications:
  1. Minimum 7 years Post Graduate of an accredited school of nursing and a current state Registered Nurse license.
  2. Minimum 3 years RN Utilization Manager working for a Health Plan.
  3. At least 3 years of experience in utilization review, referrals, authorizations, denials and appeals.
  4. Current BCLS (AHA) certificate upon hire and maintain current.
  5. Knowledge of MCG Criteria and/or InterQual Criteria required.
  6. Experience and knowledge in basic to intermediate computer skills.

Preferred qualifications:
  1. Five years acute care nursing experience preferred.
  2. Experience with self-funded health plan preferred.

Pay Transparency
Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $71,760.00 to $104,000.00 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.
Employment Status
Full Time
Shift
Days
Equal Employment Opportunity
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

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