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

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 ...

Bienestar Human Services

Nurse Practitioner

Pomona, CA

$75 - $90/hr

  • Medical

  • Dental

  • Vision

  • Retirement

Review and implement guidelines and protocols as disseminated by administration. * Respond to ... and prescription utilization in line with clinic preferred laboratory and drug formulary.

GI Excellence, Inc.

Be Seen First

Nurse Practitioner

Hemet, CA · On-site

$70 - $80/hr

Nurse Practitioner (NP) Location: Hemet, CA Employment Type: Part-Time Specialty: Gastroenterology ... Order, review, and interpret laboratory tests, imaging studies, and diagnostic procedures.

Arrowhead Orthopaedics

Nurse Practitioner

Redlands, CA · On-site

Nurse Practitioner The Nurse Practitioner (NP) will provide comprehensive care to patients with ... Visual acuity for reviewing imaging, charts, and surgical work. Work Environment Clinical offices ...

Arrowhead Orthopaedics

Nurse Practitioner

Redlands, CA · On-site

The Nurse Practitioner (NP) will provide comprehensive care to patients with acute and chronic pain ... Visual acuity for reviewing imaging, charts, and surgical work. Work Environment Clinical offices ...

Arrowhead Orthopaedics

Nurse Practitioner

Redlands, CA · On-site

$105K - $175K/yr

Job Type Full-time Description The Nurse Practitioner (NP) will provide comprehensive care to ... Visual acuity for reviewing imaging, charts, and surgical work. Work Environment Clinical offices ...

Arrowhead Orthopaedics

Nurse Practitioner

Redlands, CA · On-site

Description The Nurse Practitioner (NP) will provide comprehensive care to patients with acute and ... Visual acuity for reviewing imaging, charts, and surgical work. Work Environment Clinical offices ...

Astiva Health

UM Nurse Reviewer

Orange, CA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Utilization Management Authorization Review Nurse is responsible for managing inpatient & outpatient utilization by conducting thorough reviews of clinical documentation and applying clinical ...

Bienestar Human Services

Nurse Practitioner - PT

Pomona, CA

$75 - $90/hr

  • Medical

  • Dental

  • Vision

  • Retirement

Review and implement guidelines and protocols as disseminated by administration. * Respond to ... and prescription utilization in line with clinic preferred laboratory and drug formulary.

City of Hope

Nurse Practitioner - PATC

Irvine, CA · On-site

Nurse Practitioner Join the transformative team at City of Hope, where we're changing lives and ... programs, reviewing current literature, attending in-service meetings, and workshops. Your ...

City of Hope

Nurse Practitioner - PATC

Irvine, CA · On-site

Nurse Practitioner Join the transformative team at City of Hope, where we're changing lives and ... programs, reviewing current literature, attending in-service meetings, and workshops. Your ...

City of Hope

Nurse Practitioner - PATC

Irvine, CA

Nurse Practitioner Join the transformative team at City of Hope, where we're changing lives and ... programs, reviewing current literature, attending in-service meetings, and workshops. Your ...

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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 20, 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 Specialist PRN

Acadia Healthcare

Riverside, CA • On-site

$31 - $50/hr

Other

Re-posted 10 days ago

Acadia Healthcare rating

6.2

Company rating: 6.2 out of 10

Based on 190 frontline employees who took The Breakroom Quiz

698th of 889 rated healthcare providers

Job description

Overview
Pacific Grove Hospital in Riverside, CA., is a leader in behavioral healthcare, providing superior healthcare treatment to the people, communities, and military installations we serve. We are a private inpatient 68 bed acute psychiatric facility with out-patient services, dedicated to the treatment of behavioral health and substance abuse services. Come join TEAM PGH as a UR Specialist!
  • Flexible scheduling
  • Competitive Pay
  • Employee Assistance Program (EAP)

Hourly pay range: $31-50 DOE and licensure held
PURPOSE STATEMENT:
Proactively monitor utilization of services for patients to optimize reimbursement for the facility.
Responsibilities
ESSENTIAL FUNCTIONS:
  • Act as liaison between managed care organizations and the facility professional clinical staff.
  • Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
  • Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
  • Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
  • Conduct quality reviews for medical necessity and services provided.
  • Facilitate peer review calls between facility and external organizations.
  • Initiate and complete the formal appeal process for denied admissions or continued stay.
  • Assist the admissions department with pre-certifications of care.
  • Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.

OTHER FUNCTIONS:
  • Perform other functions and tasks as assigned.

Qualifications
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
  • Required Education: High school diploma or equivalent.
  • Preferred Education: Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
  • Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred

LICENSES/DESIGNATIONS/CERTIFICATIONS:
  • Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
  • CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
  • First aid may be required based on state or facility requirements.

ADDITIONAL REGULATORY REQUIREMENTS:
While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances
(e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.
We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.
PACGRV

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About Acadia Healthcare

Sourced by ZipRecruiter

Acadia Healthcare is a leading provider in the healthcare and hospital industry, based in Franklin, Tennessee, United States. The company is recognised for its commitment to creating a behavioural health network that provides accessible, high-quality treatment options for individuals suffering from mental health issues, addiction, eating disorders, and PTSD. Acadia Healthcare was founded in 2005, with the mission to create a world-class organization that sets the standard of excellence in the treatment of specialty behavioural health and addiction disorders.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Franklin, TN, US

Year founded

2005

Social media

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