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Utilization Review Nurse Jobs in Santa Rosa, CA (NOW HIRING)

Jconnect Infotech Inc

RN Case Manager

Saint Helena, CA · On-site

$2.7K - $2.8K/wk

CA RN license, Cerner/PowerChart experience, recent acute hospital case management experience (within the last year), discharge planning and utilization review knowledge, BSN preferred ...

GQR Global Markets

RN Case Manager

Santa Rosa, CA · On-site

$2.0K - $2.1K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Santa Rosa, California Start Date: September 8, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay ...

GQR

RN - Case Manager

Santa Rosa, CA · On-site

$2.0K - $2.1K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Santa Rosa, California Start Date: September 8, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay ...

UnitiMed

RN Case Manager

Santa Rosa, CA · On-site

Referral bonus up to $700 Registered Nurse (RN),Case Management/Utilization Review, About the Company: Uniti Med is an award-winning healthcare staffing company with a mission to provide staffing ...

Sutter Health

Care Manager II, Acute ( RN )

Novato, CA · On-site

$90.58 - $126.81/hr

Comprehensive knowledge of Utilization Review, levels of care, and observation status. * Awareness ... families/caretakers, physicians, nurses and other ancillary partners. * Ability to work ...

Sutter Health

Care Manager II, Acute ( RN )

Novato, CA

$90.58 - $126.81/hr

Comprehensive knowledge of Utilization Review, levels of care, and observation status. * Awareness ... families/caretakers, physicians, nurses and other ancillary partners. * Ability to work ...

Veracity

RN Manager - Care Management

Petaluma, CA · On-site

RN Manager - Care Management Petaluma, California Full Time 8-hour, Day shifts. Ideal Candidate ... Experience managing Care Management, Utilization Review, Discharge Planning, Care Coordination, or ...

LanceSoft

Travel Case Manager RN

Santa Rosa, CA · On-site

Work Settings Acute Hospital Case Management/Utilization Review Admission Criteria Benefits ... Posted job title: RN Case Management About LanceSoft Established in 2000, LanceSoft is a Certified ...

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All JobsUtilization Review Nurse JobsUtilization Review Nurse Jobs in Santa Rosa, CA

Utilization Review Nurse information

See Santa Rosa, CA salary details

$23

$46

$75

How much do utilization review nurse jobs pay per hour?

As of Aug 24, 2026, the average hourly pay for utilization review nurse in Santa Rosa, CA is $46.23, according to ZipRecruiter salary data. Most workers in this role earn between $36.54 and $53.08 per hour, depending on experience, location, and employer.

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 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.

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 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 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.

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For Utilization Review Nurse jobs in Santa Rosa, CA, the most frequently searched job titles are:

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What cities near Santa Rosa, CA are hiring for Utilization Review Nurse jobs?

Cities near Santa Rosa, CA with the most Utilization Review Nurse job openings:

Utilization Review Nurse jobs near you
Infographic showing various Utilization Review Nurse job openings in Santa Rosa, CA as of August 2026, with employment types broken down into 4% Internship, 56% Full Time, 4% Part Time, and 36% Contract. Highlights an 92% In-person, and 8% Remote job distribution, with an average salary of $96,155 per year, or $46.2 per hour.

Registered Nurse Utilization Review

vTech Solution

Santa Rosa, CA • On-site

Other

Re-posted 26 days ago

Job description

Job Summary:
We seek a highly skilled and experienced Registered Nurse with specialties in Medical/Surgical, ICU, ER, Psychiatric, Labor & Delivery, PACU, Operating Room. The Registered Nurse will be responsible for providing skilled nursing care, case management, and hospice care to individuals facing advancing age, frailty, and serious illness. Daily tasks include patient assessments, medication administration, treatment planning, and collaborating with the interdisciplinary team. Critical to this role is strong communication and strong collaboration with patients, providers, and other members of our team. At least 2 years of experience and exceptional skill is required.
Responsibilities:
  • Conduct patient assessments and monitor patient conditions.
  • Administer medications and treatments as prescribed.
  • Develop and implement individualized treatment plans.
  • Collaborate with interdisciplinary teams including physicians, therapists, and social workers.
  • Provide case management and hospice care for patients with advancing age, frailty, and serious illness.
  • Document patient care activities and maintain accurate medical records.
  • Communicate effectively with patients, families, and healthcare providers.
Required Skills & Certifications:
  • Active Registered Nurse license in the state of employment.
  • Bachelor's degree in Nursing or related field.
  • Minimum of 2 years' experience in hospital, home health, or hospice care.
  • Clinical assessment, medication administration, and treatment planning skills.
  • Interdisciplinary team collaboration skills.
  • Excellent communication and interpersonal skills.
  • Driver's license, car insurance, and automobile for field work.
Preferred Skills & Certifications:
  • Experience in Utilization Review or case management roles.
  • Specialty certifications relevant to Medical/Surgical, ICU, ER, Psychiatric, Labor & Delivery, PACU, or Operating Room nursing.
  • Advanced certifications such as CCRN, CMC, or CHPN.
Special Considerations:
  • May require occasional field visits necessitating reliable transportation.
  • Strong ability to work independently in remote settings.
  • Must be able to handle fast-paced and complex clinical situations.
Scheduling:
  • Remote work with flexible scheduling based on utilization review caseload.
  • Standard business hours with potential for occasional extended hours as needed.
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About vTech Solution

Sourced by ZipRecruiter

vTech is a Managed IT Services firm based out of Washington DC with a primary focus on Cloud Computing and Managed Network Security.

Industry

It services

Company size

51 - 200 Employees

Headquarters location

Washington, DC, US

Year founded

2006

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