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Utilization Review Case Management Rn Jobs in California

KPC Global MSO

Utilization Review RN (Hemet)

Hemet, CA · On-site

SUMMARY The Utilization Review RN reviews client health records to ensure proper utilization of ... Actively participates in Case Management and Treatment Team meetings * Serves as on-going educator ...

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Meda Health

Travel Utilization Review RN

Irvine, CA · On-site

Meda Health is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Irvine, California. & Requirements * Specialty: Utilization Review * Discipline: RN * Start Date ...

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Utilization Review Case Management Rn information

What cities in California are hiring for Utilization Review Case Management Rn jobs?

Cities in California with the most Utilization Review Case Management Rn job openings:

Infographic showing various Utilization Review Case Management Rn job openings in California as of June 2026, with employment types broken down into 6% As Needed, 57% Full Time, 31% Part Time, and 6% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution.

Utilization Review RN

Santa Ana, CA • On-site

Kpc Global Medical Centers Inc.
Health Care and Social Assistance • 201 - 500 employees
Learn more about Kpc Global Medical Centers Inc.external

$50 - $85/hr

Other

Posted 12 days ago

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Full Time KPC SANTA ANA, Santa Ana, CA, US

3 days ago Requisition ID: 1544

Salary Range: $50.00 To $85.00 Hourly

SUMMARY

The Utilization Review RN reviews client health records to ensure proper utilization of treatment resources.

RESPONSIBILITIES AND DUTIES:
  • Coordinates and reviews all medical records, as assigned to caseload.
  • Actively participates in Case Management and Treatment Team meetings
  • Serves as on-going educator to all departments.
  • Responsible for reviewing patient charts in order to assess whether the criteria for admission and continuation of treatment is being met; gathering data and responding to request for records from fiscal intermediary; gathering clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting
  • Able to work independently and use sound judgment.
  • Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment.
  • Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families.
  • Performs other duties as assigned.

This position is a mid-shift (3pm - 11:30pm) and will need to work on weekends.

EDUCATION & EXPERIENCE REQUIREMENTS:
  • Bachelor's or Master’s degree in social work, behavioral or mental health, nursing or other related health field preferred.
  • CA RN License Required
  • Minimum of 2 years' experience with the population of the facility and previous experience in utilization management preferred.
SKILLS & ABILITIES REQUIREMENTS:
  • Communication
  • Problem Solving
  • Attention to Detail
PHYSICAL REQUIREMENTS: Body Positions: Sitting and standing for prolonged periods. Body Movements: Arm and hand dexterity. Body Senses: Must have command of close and distant sight, color perception and hearing. Strength: Ability to lift and move up to 25-pounds.
  • Work in an office, where the climate is controlled.
  • OSHA exposure category: I
  • Category I – Position includes tasks that involve exposure to Blood borne Pathogens.
  • Category II – Position includes tasks that do not have exposure to Bloodborne Pathogens, however employment may require unplanned Category I tasks.
  • Category III – Positions includes tasks that do not involve exposure to Bloodborne Pathogens. This position would not be required to perform Category I tasks.
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About KPC Health

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KPC Health has an integrated approach to serving the people of Riverside, San Bernardino and Orange County. Our acute care medical centers provide high quality, comprehensive and affordable healthcare for the entire family. For us, healthcare is not just about caring for our patients, but also about investing in the people throughout our communities. We are one team with one mission and that mission is for all our patients, and their families to Enjoy Life in Great Health.

Industry

Health care and social assistance

Company size

201 - 500 Employees

Headquarters location

Santa Ana, CA, US

Year founded

2004

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