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Utilization Review Nurse 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 ...

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 ...

Akido

Clinical Review Nurse - Prior Authorization

Chino, CA · On-site

$62K - $93K/yr

The Clinical Review Nurse - Prior Authorization is responsible for reviewing and processing prior ... This role focuses exclusively on prior authorization activities within the Utilization Management ...

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

$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 ...

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

Utilization Review Nurse information

See Riverside, CA salary details

$22

$44

$71

How much do utilization review nurse jobs pay per hour?

As of Aug 3, 2026, the average hourly pay for utilization review nurse 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 are the key skills and qualifications needed to thrive as a utilization review nurse, and why are they important?

To thrive as a Utilization Review Nurse, you need a strong background in clinical nursing, critical thinking, and knowledge of healthcare regulations, usually supported by an RN license and nursing degree. Familiarity with utilization management software, medical coding systems (like ICD-10 and CPT), and case management certifications (such as CCM or URAC) is typically required. Excellent communication, negotiation, and organizational skills help you collaborate with providers and advocate for patient care while managing complex cases. These skills ensure appropriate resource use, regulatory compliance, and high-quality patient outcomes in healthcare settings.

What does a utilization review nurse do?

A Utilization Review Nurse is responsible for evaluating the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, coordinate with healthcare providers, and ensure that care meets established guidelines and insurance requirements. Their primary goal is to ensure patients receive appropriate care while helping to manage healthcare costs and prevent unnecessary procedures.

What are some typical challenges utilization review nurses face when communicating with healthcare providers and insurance companies?

Utilization Review Nurses often need to balance clinical judgment with insurance guidelines, which can lead to challenging conversations with providers who may disagree with coverage decisions. They must clearly explain the rationale behind approvals or denials and ensure all documentation is thorough and compliant. Navigating differing priorities while maintaining positive, professional relationships is key, and strong communication skills help facilitate collaboration and resolve conflicts efficiently.

What does a utilization review nurse do?

A utilization review nurse determines the best course of treatment for a patient using preapproved policy criteria. Utilization review nurses collect and review patient records, clinical documentation, and billing information to recommend the best use of patient care resources. Their assessments help determine the length of hospital stays, the effectiveness of the care plan, and the necessity of the services administered. Utilization review nurses inform and educate patients about their options based on their insurance benefits and limitations. Utilization review nurses also assess patient care services in clinical appeals for approval or denial.

How much do utilization review nurses make?

Utilization review nurses in Texas typically earn an average annual salary of around $70,000 to $85,000, depending on experience, certifications, and employer. Salaries can vary based on healthcare setting, location, and workload, with some experienced nurses earning higher wages or additional benefits.

What is the difference between Utilization Review Nurse vs Case Manager?

AspectUtilization Review NurseCase Manager
CredentialsRN license, certification in utilization review (e.g., URAC)RN license, case management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, insurance companies, community health settings
Employer & Industry UsagePrimarily in insurance and healthcare organizations for reviewing medical necessityIn healthcare and insurance for coordinating patient care and discharge planning

Utilization Review Nurses focus on evaluating the necessity and appropriateness of medical services, often working in insurance or healthcare settings. Case Managers coordinate patient care, discharge planning, and resource management. While both roles require RN licensure and related certifications, their primary responsibilities differ: UR Nurses review medical necessity, whereas Case Managers facilitate patient care and services.

More about Utilization Review Nurse jobs
What are the most commonly searched types of Utilization Review Nurse jobs in Riverside, CA? The most popular types of Utilization Review Nurse jobs in Riverside, CA are:
What are popular job titles related to Utilization Review Nurse jobs in Riverside, CA? For Utilization Review Nurse jobs in Riverside, CA, the most frequently searched job titles are:
What job categories do people searching Utilization Review Nurse jobs in Riverside, CA look for? The top searched job categories for Utilization Review Nurse jobs in Riverside, CA are:
What cities near Riverside, CA are hiring for Utilization Review Nurse jobs? Cities near Riverside, CA with the most Utilization Review Nurse job openings:
Utilization Review Nurse jobs near you
Infographic showing various Utilization Review Nurse job openings in Riverside, CA as of July 2026, with employment types broken down into 2% As Needed, 66% Full Time, 12% Part Time, and 20% Contract. Highlights an 99% Physical, and 1% 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

Posted 25 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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