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Utilization Review Np Jobs in Riverside, CA (NOW HIRING)

Medix

Utilization Review Nurse

Orange, CA · On-site

$38 - $53/hr

Job Summary Our client is seeking a Utilization Review Nurse responsible for managing the complete Utilization Management (UM) process, from admission through discharge planning. The primary goal is ...

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · Remote

$30.64 - $45.80/hr

The Utilization Review Nurse gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and out-patient treatment, certifies the medical necessity ...

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · On-site

$30.64 - $45.80/hr

The Utilization Review Nurse gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and out-patient treatment, certifies the medical necessity ...

CorVel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · On-site

$30.64 - $45.80/hr

The Utilization Review Nurse gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and out-patient treatment, certifies the medical necessity ...

KPC Global MSO

Utilization Review Tech

Santa Ana, CA · On-site

SUMMARY Under direction of the Utilization Review Technician Supervisor, the Utilization Review ... Position is non-RN/LVN. REQUIREMENTS * Ability to establish and maintain effective working ...

KPC Health

Utilization Review Tech

Santa Ana, CA · On-site

Utilization Review Technician Under direction of the Utilization Review Technician Supervisor, the ... Position is non-RN/LVN. Requirements * Ability to establish and maintain effective working ...

Prime Healthcare

Utilization Review RN

Ontario, CA

$71K - $104K/yr

Minimum 3 years RN Utilization Manager working for a Health Plan. * At least 3 years of experience in utilization review, referrals, authorizations, denials and appeals. * Current BCLS (AHA ...

Prime Healthcare

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

Minimum 3 years RN Utilization Manager working for a Health Plan. * At least 3 years of experience in utilization review, referrals, authorizations, denials and appeals. * Current BCLS (AHA ...

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All JobsUtilization Review Np JobsUtilization Review Np Jobs in Riverside, CA

Utilization Review Np information

See Riverside, CA salary details

$22

$44

$71

How much do utilization review np jobs pay per hour?

As of Aug 19, 2026, the average hourly pay for utilization review np in Riverside, CA is $44.11, according to ZipRecruiter salary data. Most workers in this role earn between $34.86 and $50.67 per hour, depending on experience, location, and employer.

What does a utilization review nurse practitioner do?

A Utilization Review Nurse Practitioner (NP) evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, treatment plans, and insurance coverage to ensure that care meets established guidelines and regulatory requirements. Utilization Review NPs help coordinate care, prevent unnecessary procedures, and support cost-effective healthcare delivery while ensuring patient safety and quality outcomes.

What are some common challenges utilization review nurse practitioners face when collaborating with healthcare providers and insurance companies?

Utilization Review Nurse Practitioners often navigate the challenge of balancing patient advocacy with payer requirements. They must effectively communicate clinical justifications to both healthcare providers and insurance representatives, sometimes mediating disagreements over the necessity of certain treatments or hospital stays. Staying up-to-date with ever-changing insurance guidelines and ensuring timely documentation can also be demanding, but strong organizational and interpersonal skills help facilitate smooth collaboration and successful patient outcomes.

What are the key skills and qualifications needed to thrive as a utilization review nurse practitioner, and why are they important?

To thrive as a Utilization Review Nurse Practitioner (NP), you need expert clinical judgment, a strong understanding of healthcare regulations, and advanced assessment skills, typically supported by an active NP license and clinical experience. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance guidelines such as Medicare and Medicaid are commonly required. Excellent communication, attention to detail, and critical thinking are vital soft skills for effective case evaluations and collaboration with providers. These competencies ensure accurate, efficient reviews that support quality care, compliance, and cost-effective treatment decisions.

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

AspectUtilization Review NpUtilization Review Nurse
CredentialsMaster's degree in Nursing, Nurse Practitioner certification, state licensureRegistered Nurse (RN) license, possibly with certification in utilization review
Work EnvironmentHealthcare facilities, insurance companies, utilization review organizationsHospitals, insurance companies, outpatient clinics
Job ResponsibilitiesAssess medical necessity, authorize treatments, make clinical decisions, often with greater autonomyReview medical records, support authorization processes, follow established guidelines

Utilization Review NPs typically have advanced clinical training and greater decision-making authority compared to Utilization Review Nurses. Both roles focus on evaluating medical necessity, but NPs often perform more complex assessments and can make independent recommendations, whereas nurses support the review process under supervision or guidelines.

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

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

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

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

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

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

Utilization Review Np jobs near you
Infographic showing various Utilization Review Np job openings in Riverside, CA as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 3% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $91,752 per year, or $44.1 per hour.

Utilization Review Nurse

Medix

Orange, CA • On-site

$38 - $53/hr

Full-time

Medical, Dental, Vision, Retirement

Re-posted 11 days ago

Job description

You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.
Job Summary
Our client is seeking a Utilization Review Nurse responsible for managing the complete Utilization Management (UM) process, from admission through discharge planning. The primary goal is to conduct daily inpatient reviews, concurrent reviews, discharge planning, and coordinating care for DME, Home Health, and Skilled Nursing Facility (SNF) placements.
Responsibilities / Job Duties
  • 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 Health, and SNF placements.
  • Utilize MCG criteria for clinical reviews and write formal denial letters.
  • Apply LCD/NCD to pre-service authorizations when determining appropriate clinical tiers.
  • Communicate confidently and effectively with Medical Directors, physicians, and hospital counterparts.
  • Provide clear, concise clinical case reports during daily multidisciplinary rounds.

Minimum Education and Experience Qualification Requirements
Qualifications
  • Active and unencumbered California RN or LVN License.
  • Strongly prefer 5+ years of concurrent Inpatient UM experience.
  • Direct experience working within an IPA, MSO, Delegation model, or Health Plan setting.
  • Proven, hands-on experience navigating and applying MCG criteria for inpatient acute/SNF reviews.
  • Experience in handling complex discharge planning, writing denial letters, and applying Medicare guidelines for SNF and ARU.
  • Proficiency with standard digital workspace tools (Microsoft Excel, Word, and PDFs).

Skills
  • Proficiency with MCG criteria and guidelines.
  • Effective communication with medical staff and hospital counterparts.
  • Technical skills with software tools such as Microsoft Excel, Word, and PDFs.

Schedule / Shift
Standard Shift: 8:00 AM - 5:00 PM PST, Monday through Friday, including a 1-hour lunch break, a morning break, and an afternoon break.
Benefits
  • Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
  • Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
  • 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
  • Short Term Disability Insurance.
  • Term Life Insurance Plan.

* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
Medix Overview:
With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we're dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.
* As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient's residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
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About Medix Staffing Solutions

Sourced by ZipRecruiter

Since 2001, we’ve been dedicated to helping you achieve your goals. Medix was created to become a leading provider of workforce solutions for clients and candidates across the healthcare and life sciences industries. Today, we are that leader. Headquartered in Chicago, we have 23 offices across the United States, and staff talent around the world. Medix is committed to fulfilling our core purpose as an organization: to positively impact the lives of our talent, clients, and teammates through employment, philanthropy, and opportunity. The combination of purpose and values has nurtured our thriving culture that encourages our internal team to excel at work and in everyday life.

Industry

Recruiting and staffing services

Company size

1,001 - 5,000 Employees

Headquarters location

Chicago, IL, US

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