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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 Healthcare

Travel RN Case Manager

Saint Helena, CA · On-site

$2.7K - $2.8K/wk

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: St. Helena, California Start Date: September 28, 2026 Profession: Registered Nurse (RN) Facility: Estimated ...

New

Prime Staffing

Travel RN Case Manager

Saint Helena, CA · On-site

Strong assessment, discharge planning, and utilization review skills Description: The RN Case Manager coordinates patient care plans and services across the continuum of care. Works closely with ...

New

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 ...

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 ...

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 Sep 4, 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.

More about Utilization Review Nurse jobs

What are the most commonly searched types of Utilization Review Nurse jobs in Santa Rosa, CA?

The most popular types of Utilization Review Nurse jobs in Santa Rosa, CA are:

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

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The top searched job categories for Utilization Review Nurse jobs in Santa Rosa, CA are:

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 5% Internship, 48% Full Time, 5% Part Time, and 42% Contract. Highlights an 95% In-person, and 5% Remote job distribution, with an average salary of $96,155 per year, or $46.2 per hour.

RN Case Manager

Jconnect Infotech Inc

Saint Helena, CA • On-site

$2.7K - $2.8K/wk

Contractor

Re-posted 2 days ago

Job description

Hiring: RN Case Management in  St. Helena, CA | $2800/Weekly Gross
Location: St. Helena, CA | October/November 2025 Start Date available. 
Shift: Days | 8:00 AM – 4:30 PM | 40 hours/week
Pay: $2800/week gross | $800/week taxable | $2000/week stipend | $70/hr.
Requirements:CA RN license, Cerner/PowerChart experience, recent acute hospital case management experience (within the last year), discharge planning and utilization review knowledge, BSN preferred
Responsibilities:Coordinate patient care from admission to discharge, discharge planning, utilization review, work closely with patients, families, and healthcare team
Note: Both local and travelers accepted.
To apply: Send your resume to udit@Jconnecthealthcare.com or call/text 856-288-9138
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About Jconnect Infotech

Sourced by ZipRecruiter

Jconnect Infotech is an esteemed corporation that operates within the Information Technology sector based in Noida, Uttar Pradesh, India. As a technology-driven firm, it offers various services such as IT Solutions, Software Development, Staffing Solutions and Management Consulting to businesses globally. Established as a pivotal player in its field, Jconnect Infotech was founded on the principles of delivering optimal solutions and promoting technological advancement within various industries. Their mission is to deliver innovative, cost-effective solutions and services to clients while maintaining their core values of integrity, excellence, and customer satisfaction.

Industry

Specialized design services

Company size

201 - 500 Employees

Headquarters location

Noida, Uttar Pradesh, in

Social media

Facebook

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