ZipRecruiter

Log In

1

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

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 ...

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 ...

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 ...

Astiva Health

UM Nurse Reviewer

Orange, CA · On-site

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

Critical Connection

RN - Case Management

Orange, CA · On-site

$2.5K/wk

Case management or utilization review experience preferred Compensation & Benefits * Competitive weekly pay * Guaranteed hours * First-day medical, dental, and vision insurance * Housing stipend for ...

New

previous pagenext page

Showing results 21-40

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 7, 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 August 2026, with employment types broken down into 100% Full Time. Highlights an 60% In-person, and 40% Remote job distribution, with an average salary of $91,752 per year, or $44.1 per hour.

LVN Discharge Planner

Care Navigators On Demand

Ontario, CA • On-site

$25 - $28/hr

Full-time

Re-posted 19 days ago

Job description


Under the direction of the Inpatient Review Nurse Manager and Supervisor, the incumbent will work with their respective Team Centers, that may include a Concurrent Review Nurse and Inpatient Coordinator, along with hospitals and IPAs, to initiate coordinated and continuous cost- effective discharge planning to ensure the continuity Member's care needs are met timely and readmission prevention is anticipated for IEHP Members.
Major Functions (Duties and Responsibilities)
1. Responsible for assisting with data collection for utilization review, including, but not limited to Member specific needs for daily review in anticipation of discharge needs within 24 hours of admission.
2. Responsible for the arrangement of transitions to lower or higher level of care and assists with transfer orders as needed.
3. Responsible for authorizations for outpatient services or ancillary services in preparation for the Member's discharge including, but not limited to home care, home therapies and durable medical equipment.
4. Responsible for ensuring that discharge needs for Member's include referring Members to Health Management, Health Education, Care Management, Behavioral Health or other internal or external programs as needed.
5. Anticipates and acts upon barriers to ensure effective Member progression by identifying clinical, operational, financial, and social issues that may affect patient outcomes and provides recommendation to the Concurrent Review Nurse for collaboration in an effort to assist Members with adhering to treatment plans and goals.
6. Responsible for assisting Team Center with the identification of Members who are at risk for extended lengths of stay, readmission, high utilization and/or complex discharge needs within the LVN scope of practice.5. Responsible for timely compliance and completion of cases as required by regulatory requirements.6. Responsible for working with other Team Members, departments, IPAs and the facilities to support the goals of the department as well as strategic priorities and vision of the organization.
Requirements
  • Minimum of 1 year of direct experience.
  • Valid LVN license

Apply