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Utilization Manager Jobs in Riverside, CA (NOW HIRING)

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 ...

Utilization Clerk

Corona, CA · On-site

$23 - $26/hr

Utilization Clerk (Bilingual - Spanish Required) Location: Corona, California Schedule: Full-Time ... Strong organizational and time management skills * Bilingual in English and Spanish (required)

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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 Jun 6, 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 does a Utilization Manager do?

A Utilization Manager is responsible for evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. Their primary goal is to ensure that patients receive the right care at the right time while also controlling costs for hospitals, insurance companies, or healthcare organizations. Utilization Managers review patient records, coordinate with healthcare providers, and use clinical guidelines to make informed decisions about treatment approvals or denials. They play a key role in maintaining quality care and regulatory compliance.

What are the key skills and qualifications needed to thrive as a Utilization Manager, and why are they important?

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.

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 cities near Riverside, CA are hiring for Utilization Manager jobs? Cities near Riverside, CA with the most Utilization Manager job openings:

CA Utilization Review Nurse I

Corvel

Rancho Cucamonga, CA • On-site

$30.64 - $45.80/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 6 days ago


CorVel rating

7.9

Company rating: 7.9 out of 10

Based on 50 frontline employees who took The Breakroom Quiz

81st of 138 rated financial services


Job description

The Utilization Review Nurse gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and out-patient treatment, certifies the medical necessity and assigns an appropriate length of stay while supporting the goals of the Case Management department and of CorVel.
This is a remote position.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
  • Identifies the necessity of the review process and communicates issues of concern to the appropriate claims staff/customer
  • Collects data and analyzes information to make decisions regarding certification or denial of treatment
  • Documents all work in the appropriate manner
  • Promotes utilization review services with stakeholders
  • Complies with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP)
  • Additional duties as assigned

KNOWLEDGE & SKILLS:
  • Must have thorough knowledge of both CPT and ICD coding
  • Ability to interface with claims staff, attorneys, physicians and their representatives, as well as advisors/clients and coworkers
  • Effective organization skills in a high-volume, fast-paced environment
  • Strong time management skills with the ability to meet designated deadlines
  • Excellent written and verbal communication skills
  • Ability to work both independently and within a team environment
  • Strong interpersonal skills
  • Ability to utilize Microsoft Office including Excel spreadsheets
  • Knowledge of the workers' compensation claims process preferred
  • Knowledge of outpatient utilization review preferred

EDUCATION & EXPERIENCE:
  • Graduate of accredited school of nursing with an associate's degree, Bachelor of Science degree or Bachelor of Science in Nursing
  • Current Nursing licensure in the state of operation required; RN is required unless local state regulations permit LVN/LPN
  • 4 or more years of recent clinical experience
  • Prospective, concurrent, and retrospective utilization review experience preferred
  • Experience in the clinical areas of OR, ICU, CCU, ER and/or orthopedics preferred

PAY RANGE:
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.
Pay Range: $30.64 - $45.80 per hour
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management
In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.
ABOUT CORVEL:
CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.
#LI-Remote
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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