ZipRecruiter

Log In

1

Utilization Review Case Manager Jobs in Walnut, CA

American Traveler

Travel Case Manager RN

Burbank, CA · On-site

Acute Care Facility setting within the Case Management/Utilization Review department * Day shift schedule, 5x8 hours (8:00 AM - 4:30 PM) * Patient ratio of 1:25 * No floating expected, though ...

Medix

Utilization Review Nurse

Orange, CA · On-site

$38 - $53/hr

Manage the beginning-to-end Utilization Management (UM) process through Discharge Planning ... Provide clear, concise clinical case reports during daily multidisciplinary rounds. Minimum ...

KPC Health

Utilization Review Tech

Santa Ana, CA · On-site

Performs administrative duties for the Utilization Management Department, and directed in several ... Answer and review pertinent insurance correspondence to ensure complete and accurate reimbursement ...

KPC Global MSO

Utilization Review Tech

Santa Ana, CA · On-site

SUMMARY Under direction of the Utilization Review Technician Supervisor, the Utilization Review Technician coordinates with the Utilization Management Department while being responsible for ...

next page

Showing results 1-20

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

Utilization Review Case Manager information

See Walnut, CA salary details

$16

$37

$61

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

As of Aug 26, 2026, the average hourly pay for utilization review case manager in Walnut, CA is $37.18, according to ZipRecruiter salary data. Most workers in this role earn between $30.14 and $39.18 per hour, depending on experience, location, and employer.

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 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 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 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 job categories do people searching Utilization Review Case Manager jobs in Walnut, CA look for?

The top searched job categories for Utilization Review Case Manager jobs in Walnut, CA are:

What cities near Walnut, CA are hiring for Utilization Review Case Manager jobs?

Cities near Walnut, CA with the most Utilization Review Case Manager job openings:

Utilization Review Case Manager jobs near you
Infographic showing various Utilization Review Case Manager job openings in Walnut, CA as of August 2026, with employment types broken down into 57% Full Time, and 43% Contract. Highlights an 100% In-person job distribution, with an average salary of $77,337 per year, or $37.2 per hour.

Travel RN Case Manager / Utilization Review - $2,853 per week

American Traveler

Irvine, CA • On-site

$2.8K/wk

Other

Medical, Dental, Vision, Life, Retirement

Posted 10 days ago

Job description

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

Job Description & Requirements
  • Specialty: Case Management
  • Discipline: RN
  • Start Date: 09/15/2026
  • 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: Sep 15, 2026
  • Length: 13 weeks
  • Openings: 1
Description

American Traveler is hiring an experienced RN Case Manager/Utilization Review nurse for a cancer specialty hospital, requiring 5 years of experience and an active CA RN license.

Details
  • Work in the Case Management department of a cancer specialty hospital
  • Day shift schedule, 5x8 hour shifts from 8:00 AM to 4:30 PM
  • Weekend shifts required
  • Utilizes Epic and InterQual for documentation
  • Uses SBAR communication method
Requirements
  • Active CA RN license required (must be in hand, no pending license, EMSA not accepted)
  • BSN required
  • Current BLS certification required
  • Minimum 5 years of experience required
  • Acute hospital experience required
  • Long Term Acute Care/Rehab/Skilled Nursing experience required
  • Experience with admission criteria, care coordination, and discharge planning required
  • Proficiency with InterQual Criteria and Milliman Guidelines required
  • Utilization review experience required, including appeals and denials, concurrent review, continued stay reviews, medical necessity review, and retrospective review
  • Knowledge of CMS, CPT coding, DRG, HEDIS, HIPAA, ICD-10 coding, NCQA, OSHA, and The Joint Commission standards required
  • Epic charting experience required
Additional Information
  • Responsibilities include case management and utilization review functions across the care continuum
  • Coordinate admission criteria review, care coordination, and discharge planning
  • Perform utilization review tasks including appeals, denials, concurrent and retrospective reviews, and medical necessity determinations
  • Ensure compliance with regulatory standards including CMS, HIPAA, OSHA, and The Joint Commission guidelines
  • Flu vaccine or signed declination form required during flu season (October-March)
  • No restrictive rules on requested time off
  • First-time travelers are welcome to apply
  • Travel pairs are allowed
  • Local candidates accepted at local rate within a 75-mile radius
  • Former employees of this facility will not be considered for this position

American Traveler Job ID #P-744779. 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.

American Traveler logo

About American Traveler

Sourced by ZipRecruiter

With over 20 years of success in healthcare staffing, American Traveler has established a reputation for outstanding customer service. Our full-service agency has earned top ratings from healthcare professionals in every specialty and setting. We offer travel assignments in the most sought-after locations and facilities in the country. We staff major medical centers, prestigious university teaching facilities, Magnet facilities, regional community hospitals, outpatient centers, rehab centers, skilled nursing facilities and more. With our expert team behind you every step of the way, you can enjoy a rewarding travel career that exceeds your expectations. With over 20 years of experience, American Traveler has established a reputation for outstanding customer service. With our team behind you, you can relax and enjoy a rewarding travel career.

Industry

Recruiting and staffing services

Company size

501 - 1,000 Employees

Headquarters location

Boca Raton, FL, US

Year founded

1999

View All American Traveler Jobs

Apply