ZipRecruiter

Log In

1

Utilization Review Management Jobs in California

Dignity Health

Utilization Review RN

Redding, CA · On-site

$69.95 - $93.81/hr

The position's emphasis will be on care coordination, communication and collaboration with utilization management, nursing, physicians, ancillary departments, insurers and post acute service ...

New

Acadia Healthcare

Director of Utilization

San Rafael, CA · On-site

$105K - $130K/yr

We are seeking a Director of Utilization Review to lead utilization management processes that support appropriate care delivery, regulatory compliance, and effective use of patient benefits. This ...

Acadia Healthcare

Director of Utilization

San Rafael, CA · On-site

$105K - $130K/yr

We are seeking a Director of Utilization Review to lead utilization management processes that support appropriate care delivery, regulatory compliance, and effective use of patient benefits. This ...

Bayside Marin

Director of Utilization

San Rafael, CA · On-site

$105K - $130K/yr

We are seeking a Director of Utilization Review to lead utilization management processes that support appropriate care delivery, regulatory compliance, and effective use of patient benefits. This ...

previous page

Showing results 41-60

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

Dignity Health

Redding, CA • On-site

$69.95 - $93.81/hr

Other

Posted 2 days ago

New

Dignity Health rating

7.9

Company rating: 7.9 out of 10

Based on 283 frontline employees who took The Breakroom Quiz

108th of 887 rated healthcare providers

Job description

Job Summary and Responsibilities

Position Summary:

As a RN Care Coordinator, you are responsible for overseeing the progression of care and discharge planning for identified patients requiring these services.

Every day you will leverage your expertise to provide individualized, comprehensive care, making critical assessments, performing skilled procedures, and meticulously implementing patient care plans. You'll collaborate seamlessly within an interdisciplinary team, contributing to a dynamic environment focused on optimal patient outcomes.

To be successful in this role, you will possess keen assessment skills, acute critical thinking, and a patient-first mindset, driven by a profound enthusiasm to help others. Your sense of urgency and dedication to excellence in a fast-paced environment will not only support patient recovery but also fuel your own career advancement.

  • Performs this role to meet the individual's health needs while promoting quality of care, cost effective outcomes and by following hospital policies, standards of practice and Federal and State regulations.

  • The position’s emphasis will be on care coordination, communication and collaboration with utilization management, nursing, physicians, ancillary departments, insurers and post acute service providers to progress the care toward optimal outcomes at the appropriate level of care.

  • Advocates for the patient and family by identifying, valuing, and addressing patient choice, spiritual needs, cultural, language and socioeconomic barriers to care transitions. In addition,

  • Strives to enhance the patient experience.

P

Job Requirements

Required

  • Graduate of an accredited school of nursing.

  • Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience.

  • RN license in the state(s) covered is required.

  • BLS required within 3 months of hiring

Preferred:

  • Bachelor's Degree in Nursing (BSN) or related healthcare field.

  • At least five (5) years of nursing experience.

  • Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred

  • Able to apply clinical guidelines to ensure progression of care.

  • Knowledge of managed care and payer environment preferred.

  • Must have critical thinking and problem-solving skills.

  • Collaborate effectively with multiple stakeholders

  • Professional communication skills.

  • Understand how utilization management and case management programs integrate.

  • Ability to work as a team player and assist other members of the team where needed.

  • Thrive in a fast paced, self-directed environment.

  • Knowledge of CMS standards and requirements.

  • Proficient in prioritizing work and delegating where indicated.

  • Highly organized with excellent time management skills.

Where You'll Work

Mercy Medical Center Redding offers comprehensive health care to nearly 300,000 residents in a six-county region. It is one of only two Level II trauma centers, the only Level III Neonatal Intensive Care Unit (NICU) and the only Joint Commission-certified Advanced Thrombectomy-Capable Stroke Center north of Sacramento north of Sacramento. Mercy Medical Center Redding is a 266-bed regional medical center providing inpatient and outpatient services as well as specialized cardiovascular care, stroke care, orthopedics, neurological surgery, comprehensive cancer care, maternity care, and a robust robotic surgery program. In addition, the hospital’s network of care includes Mercy Home Health and Hospice and Dignity Health Connected Living.

One Community. One Mission. One California (https://youtu.be/RrPuiSnALJY?si=pvQgPZ6ZWZM60TPV)

Pay Range

$69.95 - $93.81 /hour

We are an equal opportunity/affirmative action employer.

What Dignity Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Dignity Health logo

About Dignity Health

Sourced by ZipRecruiter

We welcome the chance to help you feel your best. Excellent, affordable health care, delivered with compassion, is what we stand for. Since our founding in 1986, we've made it our goal to create environments that meet each patient's physical, mental, and spiritual needs. We also believe this healing philosophy promotes the wellbeing of our staff and the places they serve. Dignity Health is made up of more than 60,000 caregivers and staff who deliver excellent care to diverse communities in 21 states. Headquartered in San Francisco, Dignity Health is the fifth largest health system in the nation and the largest hospital provider in California. Through teamwork and innovation, faith and compassion, advocacy and action, we endeavor every day to keep you happy, healthy, and whole.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

San Francisco, CA, US

Year founded

1986

Social media

FacebookTwitter

View All Dignity Health Jobs

Apply