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Utilization Review Coordinator Jobs in Riverside, CA

KPC Health

Utilization Review RN

Santa Ana, CA · On-site

Coordinates and reviews all medical records, as assigned to caseload. * Actively participates in ... Utilization Review and Case Management reporting * Able to work independently and use sound ...

KPC Global MSO

Utilization Review RN

Santa Ana, CA · On-site

Coordinates and reviews all medical records, as assigned to caseload. * Actively participates in ... Utilization Review and Case Management reporting * Able to work independently and use sound ...

UCI Health

RN - Utilization Review

Orange, CA · On-site

Utilization Review Nurse A utilization review nurse is a registered nurse (RN) who is responsible for ensuring patients receive necessary care without performing unnecessary or duplicate services.

KPC Health

Utilization Review RN (Hemet)

Hemet, CA · On-site

Coordinates and reviews all medical records, as assigned to caseload. * Actively participates in ... Utilization Review and Case Management reporting * Able to work independently and use sound ...

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KPC Global MSO

Utilization Review RN (Hemet)

Hemet, CA · On-site

Coordinates and reviews all medical records, as assigned to caseload. * Actively participates in ... Utilization Review and Case Management reporting * Able to work independently and use sound ...

New

Providence Service

Utilization Review RN

Irvine, CA · On-site

Description Utilization Review RN - REMOTE position. This position is Part time and will work 8- hour, Day shifts. Provide prospective, retrospective, and concurrent utilization reviews for our ...

New

Meda Health

Travel Utilization Review RN

Irvine, CA · On-site

Specialty: Utilization Review * Discipline: RN * Start Date: 10/05/2026 * Duration: 13 weeks * 40 hours per week * Shift: 8 hours, days * Employment Type: Travel IMPORTANT - TRAVEL ELIGIBILITY:

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Utilization Review Coordinator information

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How much do utilization review coordinator jobs pay per hour?

As of Sep 14, 2026, the average hourly pay for utilization review coordinator in Riverside, CA is $30.89, according to ZipRecruiter salary data. Most workers in this role earn between $22.31 and $36.11 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 the most commonly searched types of Utilization Review jobs in Riverside, CA?

The most popular types of Utilization Review jobs in Riverside, CA are:

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

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

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

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

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

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

Utilization Review Coordinator jobs near you
Infographic showing various Utilization Review Coordinator job openings in Riverside, CA as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 17% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $64,249 per year, or $30.9 per hour.

Utilization Review RN

Santa Ana, CA • On-site

KPC Health
Health Care and Social Assistance • 201 - 500 employees
Learn more about KPC Healthexternal

Other

Posted 9 days ago

Job description

Utilization Review RN

The Utilization Review RN reviews client health records to ensure proper utilization of treatment resources.

Responsibilities And Duties:
  • Coordinates and reviews all medical records, as assigned to caseload.
  • Actively participates in Case Management and Treatment Team meetings
  • Serves as on-going educator to all departments.
  • Responsible for reviewing patient charts in order to assess whether the criteria for admission and continuation of treatment is being met; gathering data and responding to request for records from fiscal intermediary; gathering clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting
  • Able to work independently and use sound judgment.
  • Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment.
  • Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families.
  • Performs other duties as assigned.

This position is a mid-shift (3pm - 11:30pm) and will need to work on weekends.

Education & Experience Requirements:
  • Bachelor's or Master's degree in social work, behavioral or mental health, nursing or other related health field preferred.
  • CA RN License Required
  • Minimum of 2 years' experience with the population of the facility and previous experience in utilization management preferred.
Skills & Abilities Requirements:
  • Communication
  • Planning & Organizing
  • Problem Solving
  • Attention to Detail
Physical Requirements:
  • Body Positions: Sitting and standing for prolonged periods.
  • Body Movements: Arm and hand dexterity.
  • Body Senses: Must have command of close and distant sight, color perception and hearing.
  • Strength: Ability to lift and move up to 25-pounds.
Working Environment:
  • Work in an office, where the climate is controlled.
  • OSHA exposure category: I
  1. Category I – Position includes tasks that involve exposure to Blood borne Pathogens.
  2. Category II – Position includes tasks that do not have exposure to Bloodborne Pathogens, however employment may require unplanned Category I tasks.
  3. Category III – Positions includes tasks that do not involve exposure to Bloodborne Pathogens. This position would not be required to perform Category I tasks.
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About KPC Health

Sourced by ZipRecruiter

KPC Health has an integrated approach to serving the people of Riverside, San Bernardino and Orange County. Our acute care medical centers provide high quality, comprehensive and affordable healthcare for the entire family. For us, healthcare is not just about caring for our patients, but also about investing in the people throughout our communities. We are one team with one mission and that mission is for all our patients, and their families to Enjoy Life in Great Health.

Industry

Health care and social assistance

Company size

201 - 500 Employees

Headquarters location

Santa Ana, CA, US

Year founded

2004

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