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Utilization Review Case Manager Jobs in Riverside, CA

Prime Staffing

Travel ED Case Manager

Orange, CA · On-site

Experience with Utilization Review and Care Coordination * Strong understanding of Admission ... Case Management * Utilization Management * Care Coordination * Discharge Planning * Needs ...

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Utilization Review Case Manager information

See Riverside, CA salary details

$17

$38

$62

How much do utilization review case manager jobs pay per hour?

As of Jul 14, 2026, the average hourly pay for utilization review case manager in Riverside, CA is $38.06, according to ZipRecruiter salary data. Most workers in this role earn between $30.87 and $40.14 per hour, depending on experience, location, and employer.

What are some common challenges Utilization Review Case Managers face when coordinating care across multiple departments?

Utilization Review Case Managers often navigate complex communication between physicians, nursing staff, insurance providers, and patients to ensure appropriate care and resource use. Balancing timely authorizations with evolving patient needs and varying documentation standards can be challenging. Additionally, staying current with changing regulations and payer requirements requires ongoing learning and adaptability. Building strong collaborative relationships and maintaining clear, concise documentation are key strategies for overcoming these hurdles.

What is a Utilization Review Case Manager?

A Utilization Review Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical treatments and services provided to patients. They review clinical information, coordinate with providers and insurance companies, and ensure that patient care aligns with established guidelines and policies. Their goal is to optimize patient outcomes while managing healthcare costs and ensuring compliance with regulations.

What is the difference between Utilization Review Case Manager vs Utilization Review Nurse?

AspectUtilization Review Case ManagerUtilization Review Nurse
CredentialsTypically requires a nursing license or relevant healthcare certificationRegistered Nurse (RN) license is required
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinic, insurance review departments
Primary FocusReviewing medical necessity, coordinating care, managing casesAssessing medical records, clinical review, patient care evaluation

Both roles involve healthcare review and require nursing credentials, but the Utilization Review Case Manager often focuses on coordinating care and managing cases, while the Utilization Review Nurse emphasizes clinical assessment and review of medical records. Understanding these differences helps in choosing the right career path or job search focus.

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

To thrive as a Utilization Review Case Manager, you need a clinical background such as an RN or LCSW license, strong knowledge of medical necessity criteria, and experience with case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory guidelines like Medicare and Medicaid are essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration between patients, providers, and payers. These skills ensure appropriate resource use, compliance with regulations, and high-quality patient care.
What are popular job titles related to Utilization Review Case Manager jobs in Riverside, CA? For Utilization Review Case Manager jobs in Riverside, CA, the most frequently searched job titles are:
What job categories do people searching Utilization Review Case Manager jobs in Riverside, CA look for? The top searched job categories for Utilization Review Case Manager jobs in Riverside, CA are:
What cities near Riverside, CA are hiring for Utilization Review Case Manager jobs? Cities near Riverside, CA with the most Utilization Review Case Manager job openings:
Utilization Review Case Manager jobs near you

Utilization Management Authorization Assistant

Redlands Community Hospital - UTILIZATION MANAGEMENT SUPPORT

Redlands, CA • On-site

$23 - $29.35/hr

Other

Re-posted 15 days ago

Job description

Hourly pay range: $23.00 min. - $29.35 max.


Reporting to the Director of Social Services, this position keeps records, authorizations, and paperwork for the department to ensure the financial needs that relate to the following areas are correct for hospital billing: acute admissions, outpatient services and surgeries. This position is a liaison to outside review agencies for information, coordinating this information to the proper hospital department and investigating if a problem is identified.



Ability to meet all job & physical requirements as outlined in job description or as agreed through a work place accommodation.


EDUCATION/TRAINING/ EXPERIENCE:


  1. High School graduation or equivalent preferred.
  2. Two years of experience of acute hospital setting in utilization review, case management, business office or related department preferred.
  3. Experience in a managed care environment is desirable.
  4. Strong knowledge of medical terminology preferred.

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