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Utilization Review Coordinator Jobs in Santa Rosa, CA

Prime Staffing

Travel RN Case Manager

Saint Helena, CA · On-site

Strong assessment, discharge planning, and utilization review skills Description: The RN Case Manager coordinates patient care plans and services across the continuum of care. Works closely with ...

New

Sutter Health

Care Manager II, Acute ( RN )

Novato, CA · On-site

$90.58 - $126.81/hr

Responsible for Care Coordination and Care Transitions Planning throughout the acute care patient ... Comprehensive knowledge of Utilization Review, levels of care, and observation status. * Awareness ...

Sutter Health

Care Manager II, Acute ( RN )

Novato, CA · On-site

$90.58 - $126.81/hr

Responsible for Care Coordination and Care Transitions Planning throughout the acute care patient ... Comprehensive knowledge of Utilization Review, levels of care, and observation status. * Awareness ...

LanceSoft

Travel Case Manager RN

Santa Rosa, CA · On-site

Work Settings Acute Hospital Case Management/Utilization Review Admission Criteria Benefits Eligibility Care coordination Discharge Planning Needs Assessment/ Order DME Plan of Care Prior ...

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Utilization Review Coordinator information

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$32

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How much do utilization review coordinator jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for utilization review coordinator in Santa Rosa, CA is $32.37, according to ZipRecruiter salary data. Most workers in this role earn between $23.41 and $37.84 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 Santa Rosa, CA?

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

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

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

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

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

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

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

Utilization Review Coordinator jobs near you
Infographic showing various Utilization Review Coordinator job openings in Santa Rosa, CA as of August 2026, with employment types broken down into 1% As Needed, 75% Full Time, 20% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $67,333 per year, or $32.4 per hour.

Case Manager-St. Helena-CA--Pay Negotiable

TMS

Saint Helena, CA • On-site

$2.8K - $3.2K/wk

Contractor

Re-posted 18 days ago

Job description

Registered Nurse (RN) – Case Manager

Job Summary:
The Registered Nurse (RN) – Case Manager coordinates patient care across the continuum to promote quality outcomes, appropriate resource utilization, and timely discharge planning. The RN collaborates with physicians, patients, families, and the interdisciplinary healthcare team to develop individualized care plans, facilitate transitions of care, and ensure compliance with regulatory and payer requirements.

Requirements:

  • Associate Degree in Nursing (ASN) required; Bachelor of Science in Nursing (BSN) preferred.

  • Current Registered Nurse (RN) license in the state of practice.

  • Current BLS certification preferred or required per facility policy.

  • Case Management (CCM or ACM) certification preferred.

  • Recent case management, utilization review, discharge planning, or acute care nursing experience preferred.

Responsibilities:

  • Assess patient needs and develop individualized case management and discharge plans.

  • Coordinate care with physicians, nurses, social workers, therapists, and community resources.

  • Facilitate appropriate utilization of healthcare services and ensure timely transitions of care.

  • Monitor patient progress and revise care plans as needed.

  • Educate patients and families regarding treatment plans, discharge instructions, and available resources.

  • Maintain accurate clinical documentation and ensure compliance with regulatory and payer requirements.

  • Advocate for patients to promote quality, cost-effective, and patient-centered care.

  • Collaborate with the interdisciplinary healthcare team to improve patient outcomes.

  • Follow HIPAA, patient safety, and organizational policies.

  • Perform other duties as assigned.