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

Prime Healthcare

Utilization Review Nurse LVN

Ontario, CA · On-site

$71K - $99K/yr

Possess an active CA Licensed Vocational Nurse (LVN) license. * Minimum (2) two years of experience ... Utilization Management experience required. * Excellent interpersonal relationship skills with ...

Astiva Health, Inc

UM Nurse Reviewer

Orange, CA · On-site

Utilization Management Authorization Review Nurse Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering ...

Acadia Healthcare

Utilization Specialist PRN

Riverside, CA · On-site

$31 - $50/hr

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...

Acadia Healthcare

Utilization Specialist PRN

Riverside, CA · On-site

$31 - $50/hr

Conduct reviews in accordance with certification requirements of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...

Acadia Healthcare

Utilization Specialist PRN

Riverside, CA · On-site

$31 - $50/hr

Conduct reviews in accordance with certification requirements of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...

Pacific Grove

Utilization Specialist PRN

Riverside, CA · On-site

$31 - $50/hr

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...

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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.

Travel RN Case Manager / Utilization Review - $2,853 per week

American Traveler

Irvine, CA • On-site

$2.8K/wk

Other

Medical, Dental, Vision, Life, Retirement

Posted 3 days ago

New

Job description

American Traveler is seeking a travel nurse RN Case Management for a travel nursing job in Irvine, California.

Job Description & Requirements
  • Specialty: Case Management
  • Discipline: RN
  • Start Date: 09/15/2026
  • Duration: 13 weeks
  • 40 hours per week
  • Shift: 8 hours, days
  • Employment Type: Travel
Assignment Overview
  • Shift: Days, 5x8hrs
  • Hours: 40 hrs/wk
  • Start Date: Sep 15, 2026
  • Length: 13 weeks
  • Openings: 1
Description

American Traveler is hiring an experienced RN Case Manager/Utilization Review nurse for a cancer specialty hospital, requiring a BSN, active CA RN license, and 5 years of relevant experience.

Details
  • Case Management/Utilization Review position at a cancer specialty hospital
  • Day shift schedule, 5x8-hour shifts from 8:00 AM to 4:30 PM
  • Weekend work required
  • Utilizes Epic EMR and InterQual documentation
  • Uses SBAR communication method
Requirements
  • Active CA RN license required in hand, no pending licenses accepted
  • BSN required
  • Current BLS certification required
  • Minimum 5 years of case management/utilization review experience required
  • Acute hospital and Long Term Acute Care/Rehab/Skilled Nursing experience required
  • Experience with InterQual Criteria and Milliman Guidelines required
  • Utilization review experience including admission criteria, appeals and denials, concurrent review, continued stay reviews, medical necessity, and retrospective review
  • Knowledge of CMS, CPT coding, DRG, HEDIS, HIPAA, ICD-10 coding, NCQA, OSHA, and Joint Commission standards
  • Care coordination and discharge planning experience required
  • Epic charting experience required
Additional Information
  • Responsible for care coordination, discharge planning, and utilization review functions
  • Conducts admission criteria reviews, appeals and denials management, and concurrent and retrospective reviews
  • Ensures compliance with regulatory standards including CMS, HIPAA, and Joint Commission requirements
  • Flu vaccine or signed declination form required during flu season (October-March)
  • No restrictive rules on requested time off
  • First-time travelers are welcome to apply
  • Travel pairs are allowed
  • Local candidates accepted within a 75-mile radius at local rate
  • Former employees will not be considered for this position

American Traveler Job ID #P-744779. Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Travel RN - Case Management/Utilization Review - Case Management

About American Traveler

With over 25 years of experience, American Traveler has established a reputation for outstanding customer service. Our team ensures a smooth, worry-free experience for those starting on or expanding their travel nursing and allied careers.

With thousands of travel nursing and allied jobs nationwide, our attentive and approachable recruiters find positions that align perfectly with your career aspirations and personal requirements.

American Traveler offers exceptional benefits, including premium medical, dental, vision and life insurance beginning day one of your assignment, generous 401(k) match, substantial housing stipends, and more. Additionally, with 24/7 support and access to our in-house clinicians, you are assured confidence and comfort throughout your assignment.

With our team behind you, you can relax and enjoy a rewarding travel career.

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