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Utilization Review Case Manager Jobs in Riverside, CA

Dragonfly Recruiting

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Utilization Management Inpatient Coordinator

Orange, CA · Remote

$23 - $26/hr

Communicate with hospital utilization review departments, case managers, and facility staff regarding documentation and member status. * Enter and review ICD-10 and CPT codes related to inpatient ...

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Dragonfly Recruiting

Be Seen First

Utilization Management Inpatient Coordinator

Orange, CA · Remote

$23 - $26/hr

Communicate with hospital utilization review departments, case managers, and facility staff regarding documentation and member status. * Enter and review ICD-10 and CPT codes related to inpatient ...

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Cynet Health

RN - Case Manager

Irvine, CA

This position is for a complex inpatient case manager and utilization review RN. Candidates must ... have five years of experience in the specialty area. Responsibilities include evaluating patient ...

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Utilization Review Case Manager information

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

As of May 31, 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 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 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 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
Travel Inpatient Oncology RN Case Manager

Travel Inpatient Oncology RN Case Manager

American Traveler

Irvine, CA

Contractor

Medical, Dental, Vision, Life, Retirement

Posted 3 days ago

Job description

American Traveler is seeking a travel nurse RN Case Manager, Acute Care Case Management for a travel nursing job in Irvine, California.

Job Description & Requirements
  • Specialty: Acute Care Case Management
  • Discipline: RN
  • Start Date: 06/16/2026
  • Duration: 13 weeks
  • 40 hours per week
  • Shift: 8 hours, days
  • Employment Type: Travel
Assignment Overview
  • Shift: Days, 5x8hrs
  • Hours: 40 hrs/wk
  • Start Date: Jun 16, 2026
  • Length: 13 weeks
  • Openings: 2
Description

American Traveler is hiring an experienced RN Case Manager for a Cancer Specialty Hospital, requiring 5 years of specialty experience and proficiency in Epic and InterQual.

Details
  • Inpatient Case Management and Utilization Review role within a Cancer Specialty Hospital
  • Handles complex inpatient case management including care coordination, discharge planning, and utilization review
  • Utilizes Epic EMR and InterQual for documentation and clinical decision support
  • Applies InterQual and Milliman criteria for UR admission, concurrent review, continued stay, retrospective review, medical necessity, appeals, and denials
  • Day shift schedule, 5x8-hour shifts (8:00–16:30)
  • Rotating weekends required
Requirements
  • Active CA RN license required
  • BSN required
  • Current BLS certification required
  • Minimum 5 years of specialty Case Management/UR experience required
  • Acute hospital and long-term acute care, rehab, or SNF experience required
  • Proficiency with Epic EMR required
  • Experience with InterQual and Milliman criteria required
  • Working knowledge of ICD-10 coding, CPT coding and billing, and DRG required
  • Familiarity with CMS, HIPAA, NCQA, HEDIS, OSHA, and Joint Commission/Core Measures/National Safety Goals required
  • Workers' compensation experience required
Additional Information
  • Responsibilities include UR admission criteria review, concurrent and continued stay reviews, retrospective reviews, and managing appeals and denials
  • SBAR communication framework used for clinical handoffs and team communication
  • Role involves coordination across disciplines to facilitate appropriate admission criteria, care transitions, and discharge planning

American Traveler Job ID #P-713360. Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Travel RN - Case Management/Utilization Review - Case Management

About American Traveler

With over 25 years of experience, American Traveler has established a reputation for outstanding customer service. Our team ensures a smooth, worry-free experience for those starting on or expanding their travel nursing and allied careers.

With thousands of travel nursing and allied jobs nationwide, our attentive and approachable recruiters find positions that align perfectly with your career aspirations and personal requirements.

American Traveler offers exceptional benefits, including premium medical, dental, vision and life insurance beginning day one of your assignment, generous 401(k) match, substantial housing stipends, and more. Additionally, with 24/7 support and access to our in-house clinicians, you are assured confidence and comfort throughout your assignment.

With our team behind you, you can relax and enjoy a rewarding travel career.

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