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Utilization Review Coordinator Jobs in Rialto, CA

Bestica

Travel Case Manager RN

Apple Valley, CA · On-site

Acute hospital case management / utilization review * Admission criteria and benefits eligibility * Care coordination and discharge planning * Disease management and plan of care * Needs assessment ...

American Traveler

Travel RN Case Manager

Orange, CA · On-site

Case Management/Utilization Review role supporting Breast Cancer Screening and Breast nodule/mass ... Care coordination and data abstraction experience required * Epic EMR experience required, must be ...

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All JobsUtilization Review JobsUtilization Review Coordinator JobsUtilization Review Coordinator Jobs in Rialto, CA

Utilization Review Coordinator information

See Rialto, CA salary details

$15

$29

$46

How much do utilization review coordinator jobs pay per hour?

As of Sep 5, 2026, the average hourly pay for utilization review coordinator in Rialto, CA is $29.69, according to ZipRecruiter salary data. Most workers in this role earn between $21.44 and $34.71 per hour, depending on experience, location, and employer.

What does a utilization review coordinator do?

A Utilization Review Coordinator is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, treatment plans, and insurance information to ensure that care meets established guidelines and regulatory requirements. By coordinating between healthcare providers, insurance companies, and patients, Utilization Review Coordinators help optimize resource use and manage healthcare costs while ensuring quality patient care.

What skills and qualifications are needed to be a utilization review coordinator?

To thrive as a Utilization Review Coordinator, you need expertise in healthcare regulations, clinical guidelines, and case management, often supported by an RN license or a background in health administration. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance approval processes are typically required. Strong analytical thinking, attention to detail, and effective communication skills help you collaborate with providers and advocate for appropriate patient care. These skills ensure compliance, optimize resource use, and support quality care delivery within healthcare organizations.

How does a utilization review coordinator collaborate with healthcare providers and insurance companies?

A Utilization Review Coordinator regularly communicates with both healthcare providers and insurance companies to ensure that patients receive appropriate care while managing costs. They review medical records and treatment plans, discuss cases with physicians to clarify medical necessity, and submit documentation to insurance payers for approval. This role requires strong interpersonal skills, as coordinators often need to negotiate coverage decisions and resolve discrepancies between clinical teams and insurers. Effective collaboration ensures timely authorizations and helps avoid unnecessary delays in patient care.

What is the difference between Utilization Review Coordinator vs Utilization Review Nurse?

AspectUtilization Review CoordinatorUtilization Review Nurse
CredentialsTypically requires a healthcare-related certification or associate degreeRegistered Nurse (RN) license required
Work EnvironmentOffice setting, administrative tasks, coordinationClinical setting, patient chart review, direct communication with healthcare providers
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance companies, healthcare providers
Common Search & ComparisonFocuses on administrative review processesInvolves clinical assessment and patient care considerations

While both roles involve reviewing healthcare utilization, the Utilization Review Coordinator primarily handles administrative and coordination tasks, often without direct patient contact, whereas the Utilization Review Nurse performs clinical assessments as a licensed RN, often in hospital or clinical settings. Understanding these differences helps job seekers identify the right role based on their credentials and career goals.

What are popular job titles related to Utilization Review Coordinator jobs in Rialto, CA?

For Utilization Review Coordinator jobs in Rialto, CA, the most frequently searched job titles are:

What job categories do people searching Utilization Review Coordinator jobs in Rialto, CA look for?

The top searched job categories for Utilization Review Coordinator jobs in Rialto, CA are:

What cities near Rialto, CA are hiring for Utilization Review Coordinator jobs?

Cities near Rialto, CA with the most Utilization Review Coordinator job openings:

Utilization Review Coordinator jobs near you
Infographic showing various Utilization Review Coordinator job openings in Rialto, CA as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 11% Part Time, 2% Contract, and 1% Nights. Highlights an 78% Physical, 2% Hybrid, and 20% Remote job distribution, with an average salary of $61,756 per year, or $29.7 per hour.

Utilization Review Nurse LVN

Prime Healthcare Management Inc

Ontario, CA • On-site

$71K - $99K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 15 days ago

Prime Healthcare rating

6.4

Company rating: 6.4 out of 10

Based on 289 frontline employees who took The Breakroom Quiz

650th of 898 rated healthcare providers

Job description

Overview
Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation's leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!
Responsibilities
Responsible for the daily coordination and oversight to the Referral Technicians with regard to referral distribution and tracking. Assists Director of UR Dept. in providing oversight and monitoring productivity of UR Coordinators and Referral Technicians. Provides training to new staff on system and referral processes. Assists physician offices and vendors with problem resolution. Knowledgeable in policies, procedures and practices and keeps updated with regulations applicable to the department including applicable regulations pertinent to Self-Funded Plan.
Qualifications
Education and Work Experience
Required qualifications:
  1. Possess an active CA Licensed Vocational Nurse (LVN) license.
  2. Minimum (2) two years of experience in acute hospital case management or equivalent.
  3. Utilization Management experience required.
  4. Excellent interpersonal relationship skills with exceptional professional work ethics.
  5. Extensive knowledge of professional and hospital claims.
  6. Extensive knowledge of coding, billing.
  7. High School Diploma or GED

Preferred qualifications:
  1. Experience and knowledge of Self-Funded plans, HMO plans, ERISA, and HIPAA guidelines.

Pay Transparency
Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $71,760.00 to $99,590.00 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.
Employment Status
Full Time
Shift
Days
Equal Employment Opportunity
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

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