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Utilization Review Case Manager Jobs in Riverside, CA

American Traveler

Travel RN Case Manager

Orange, CA

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 ...

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All JobsUtilization Review Case Manager JobsUtilization Review Case Manager Jobs in Riverside, CA

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 Jun 23, 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 Review Registered Nurse (RN) - 26-07363

NavitasPartners

Fontana, CA

$35/hr

Other

Posted 5 days ago

Job description

Utilization Review Registered Nurse (RN)

Specialty: Utilization Review / Case Management
Location: Apple Valley, California (CA)
Duration: 13 Weeks

Position Overview

We are seeking an experienced Utilization Review Registered Nurse (RN) to support utilization management activities within an acute care hospital setting. The ideal candidate will have recent hospital-based utilization review experience and a strong understanding of medical necessity criteria, regulatory requirements, and care coordination processes.

Schedule
  • Day Shift
  • Weekend Requirement: Minimum of 4 weekend day shifts within a 6-week period (additional weekends may be required)
Required Licensure
  • Active California RN License required
  • Pending California license accepted, but license must be active by the start date
Experience Requirements
  • Minimum 3 years of acute care Utilization Review or Care Management experience in a hospital setting
  • Experience must be hospital-based; health plan and medical group experience alone will not qualify
  • Seasoned traveler required
  • First-time travelers will not be considered
Patient Ratio
  • Approximately 1:40
Required Skills
  • Utilization Review
  • Medical Necessity Review
  • Concurrent Review
  • InterQual and/or Milliman Guidelines
  • Care Coordination
  • Discharge Planning Collaboration
  • Denial Prevention and Management
  • Regulatory Compliance
  • Clinical Documentation Review
  • Electronic Medical Record Documentation
Responsibilities
  • Perform utilization review activities to ensure appropriate level of care and resource utilization
  • Evaluate admissions, continued stays, and services for medical necessity
  • Collaborate with physicians, case managers, and interdisciplinary teams
  • Identify and address barriers to care progression and discharge
  • Ensure compliance with regulatory, payer, and facility requirements
  • Maintain accurate and timely documentation of utilization review activities
  • Assist in denial prevention and appeals processes as needed

For more details reach at sthakur@navitashealth.com or Call / Text at 732 791 4807 - EXT 4807.

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