ZipRecruiter

Log In

1

Utilization Review Management Jobs in California

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 ...

Medix

Utilization Review Nurse

Orange, CA · On-site

$38 - $53/hr

Manage the beginning-to-end Utilization Management (UM) process through Discharge Planning. * Conduct daily inpatient review, concurrent review, discharge planning, and coordinate care for DME, Home ...

Sutter Health

Utilization Review Tech III

San Mateo, CA · On-site

$48.91 - $68.47/hr

Reports out monthly (and as needed) on denials and other utilization management subjects ... Critical thinking skills necessary to provide utilization review/discharge planning services ...

next page

Showing results 1-20

All JobsUtilization Review Management JobsUtilization Review Management Jobs in California

Utilization Review Management information

See California salary details

$15

$31

$52

How much do utilization review management jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for utilization review management in California is $31.52, according to ZipRecruiter salary data. Most workers in this role earn between $22.07 and $40.10 per hour, depending on experience, location, and employer.

What are the job titles for utilization review management?

Job titles in utilization review management include Utilization Review Nurse, Utilization Review Coordinator, Utilization Review Nurse Case Manager, and Utilization Review Supervisor. These roles typically involve assessing medical necessity, reviewing patient records, and ensuring compliance with healthcare policies, often requiring certification such as the Certified Professional in Healthcare Quality (CPHQ).

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

AspectUtilization Review ManagementUtilization Review Nurse
CredentialsTypically requires a healthcare management or related certification, sometimes a nursing backgroundRegistered Nurse (RN) license, often with additional utilization review certification
Work EnvironmentOffice-based, administrative setting, collaborating with healthcare providers and insurance companiesClinical setting, reviewing patient charts, and making utilization decisions
Employer & IndustryHealth insurance companies, managed care organizations, healthcare administratorsHospitals, insurance companies, healthcare facilities

Utilization Review Management professionals focus on overseeing review processes, policy compliance, and administrative tasks, while Utilization Review Nurses conduct clinical assessments to determine appropriate care. Both roles are essential in healthcare utilization management but differ in responsibilities and work environment.

What are some common challenges faced by professionals in utilization review management, and how can they be addressed?

Professionals in Utilization Review Management often encounter challenges such as balancing regulatory compliance with patient advocacy and managing high caseloads under tight deadlines. Navigating complex insurance policies and ensuring timely communication between healthcare providers and payers can be demanding. Staying organized, leveraging technology for workflow management, and participating in ongoing training can help address these challenges. Additionally, strong collaboration with interdisciplinary teams ensures more effective and efficient utilization review processes.

What is utilization review management?

Utilization Review Management is a process used in healthcare to evaluate the necessity, appropriateness, and efficiency of medical services, procedures, and facilities. Its primary goal is to ensure that patients receive appropriate care while preventing unnecessary or duplicative services. Utilization Review Management helps healthcare providers and insurance companies manage costs, maintain high-quality care, and comply with regulations. Professionals in this field often review patient records, coordinate with clinicians, and make recommendations about coverage or care plans.

What are the key skills and qualifications needed to thrive in utilization review management?

To thrive in Utilization Review Management, you need a solid background in healthcare, strong analytical skills, and often a clinical degree such as RN or LPN, with certification in utilization review or case management being highly beneficial. Familiarity with medical coding systems (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required. Excellent communication, critical thinking, and negotiation skills help you collaborate with providers and payers while advocating for patient care. These competencies are vital for ensuring appropriate resource use, regulatory compliance, and optimal patient outcomes.
What cities in California are hiring for Utilization Review Management jobs? Cities in California with the most Utilization Review Management job openings:
Utilization Review Management jobs near you
Infographic showing various Utilization Review Management job openings in California as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 2% Temporary, and 2% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $65,566 per year, or $31.5 per hour.

Utilization Review RN (Hybrid)

Vivo HealthStaff

Daly City, CA • On-site

Full-time

Re-posted yesterday

Job description

Vivo HealthStaff is searching for a Utilization Review RN for a hybrid position for a health plan in San Francisco. It is a hybrid position with 1-2 days per week on-site required.Collaborates with the physician, nurse case manager, social worker, and other members of the health care team to meet individualized patient outcomes. Performs concurrent, and retrospective medical record reviews based on approved screening criteria, knowledge of insurance coverage, and communication with the third-party payers. Ensures medical necessity determinations, service authorization and concurrent denials are managed effectively and financially responsibly.EducationValid RN license in State of CaliforniaBachelor's degree in NursingExperienceClinical experience in acute care setting RequiredExperience with interqual and millimen PreferredLicenses and CertificationsCPR - Cardiac Pulmonary Resuscitation CPR/BLS Preferred andCCM - Certified Case Manager CCM Preferred andACMA PreferredKnowledge, Skills, and AbilitiesVerbal and written communication skills.Basic computer skills.Diagnostic and problem-solving skills.Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.Actively participates in ongoing professional enrichment and educational opportunities. Collaborates with and assists the nurse case manager and social worker to meet the patients' continuing health needs in a high quality, cost effective manner. Participates in planning rounds as needed to address and communicate issues related to acuity level of patient, LOS insurance and discharge needs.Collects quality improvement data in accordance with approved indicators. Recognizes potential problems and makes referrals to quality improvement, risk management, safety, infection control, and other departments as appropriate.Confers and collaborates routinely with the physician advisor, division chiefs, and attending physicians to resolve problems regarding acuity and level of care.Evaluates concurrent and retrospective denials for appeal opportunities. May generate appeal letters based on knowledge of clinical severity and intensity.Identifies insurance information, obtains authorization, communicates with financial counseling and assigns appropriate length of stay for admission.Implements strategies to avoid denials including potential denial notification to attending physician. Issues letter of non-coverage for Medicare or third party payers according to policies and procedures. Communicates utilization plans to case management team.Performs admission reviews and subsequent concurrent reviews to determine the necessity for acute care by application of accepted criteria based on age specific needs. Interacts with and assists third party payer reviewers to facilitate appropriate care and ensure payment for services. Performs concurrent and retrospective reviews telephonically as required. Completes all forms and documentation necessary to support appropriate utilization of resources.Serves as a resource to all staff in areas of utilization review/management. Educates members of health care team through in-services, staff meetings, orientation and formal educational offerings.Demonstrates knowledge of the dynamics of abuse/neglect, including identification and reporting laws. Coordinates with investigating law enforcement, protection agencies, hospital security, risk management, and healthcare team. Demonstrates knowledge of community resources serving the high social risk populations.Performs other duties as assigned.
Vivo HealthStaff logo

About Vivo HealthStaff

Sourced by ZipRecruiter

Vivo HealthStaff provides permanent recruitment services for both clinical and administrative positions in the healthcare sector. Over the past 2 years, our clients have seen a 98% retention rate with Vivo HealthStaff placements.

Industry

Health care and social assistance

Company size

11 - 50 Employees

Headquarters location

Dublin, CA, US

Year founded

2016

Social media

FacebookTwitter

View All Vivo HealthStaff Jobs