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Utilization Review Physician Assistant Jobs in Riverside, CA

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 ... Communicate confidently and effectively with Medical Directors, physicians, and hospital ...

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 ... Ability to interface with claims staff, attorneys, physicians and their representatives, as well as ...

Prime Healthcare

Utilization Review RN

Ontario, CA

$71K - $104K/yr

It is one of the nation's leading health systems with over 60,000 employees and physicians. Twenty ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...

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 ... Ability to interface with claims staff, attorneys, physicians and their representatives, as well as ...

Prime Healthcare

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

It is one of the nation's leading health systems with over 60,000 employees and physicians. Twenty ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...

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 ... Ability to interface with claims staff, attorneys, physicians and their representatives, as well as ...

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 ... Initiate and complete the formal appeal process for denied admissions or continued stay. * Assist ...

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 ... Initiate and complete the formal appeal process for denied admissions or continued stay. * Assist ...

Pacific Grove

Utilization Specialist PRN

Riverside, CA · On-site

$31 - $50/hr

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Initiate and complete the formal appeal process for denied admissions or continued stay. * Assist ...

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 ... Initiate and complete the formal appeal process for denied admissions or continued stay. * Assist ...

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All JobsUtilization Review Physician JobsUtilization Review Physician Assistant JobsUtilization Review Physician Assistant Jobs in Riverside, CA

Utilization Review Physician Assistant information

See Riverside, CA salary details

$43.8K

$145.9K

$195.6K

How much do utilization review physician assistant jobs pay per year?

As of Aug 10, 2026, the average yearly pay for utilization review physician assistant in Riverside, CA is $145,939.00, according to ZipRecruiter salary data. Most workers in this role earn between $126,800.00 and $163,800.00 per year, depending on experience, location, and employer.

What is a utilization review physician assistant?

A Utilization Review Physician Assistant (PA) is a healthcare professional who evaluates medical records and treatment plans to ensure that patient care is medically necessary, appropriate, and cost-effective. They review cases to determine if the care provided meets established guidelines and insurance requirements. Utilization Review PAs collaborate with physicians, nurses, insurance companies, and other healthcare providers to promote quality care while managing healthcare resources efficiently. Their work typically involves less direct patient care and more administrative responsibilities compared to traditional clinical PA roles.

What are the key skills and qualifications needed to thrive as a utilization review physician assistant?

To thrive as a Utilization Review Physician Assistant, you need a strong clinical background, current PA licensure, and in-depth knowledge of medical guidelines and insurance protocols. Familiarity with electronic medical records (EMRs), utilization management software, and relevant certification such as the Certified Professional in Utilization Review (CPUR) is often beneficial. Strong analytical thinking, attention to detail, and effective communication are crucial soft skills for evaluating cases and interacting with healthcare providers and payers. These competencies are essential to ensure appropriate care delivery, compliance with regulations, and cost-effective use of medical resources.

What is the difference between Utilization Review Physician Assistant vs Utilization Review Nurse Practitioner?

AspectUtilization Review Physician AssistantUtilization Review Nurse Practitioner
CredentialsMaster's degree, Physician Assistant (PA) license, certification (e.g., NCCPA)Master's or higher degree, Nurse Practitioner (NP) license, certification (e.g., ANCC, AANP)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, clinics, insurance companies
Employer & Industry UsageCommonly employed in healthcare and insurance sectors for review rolesSimilar usage, often in outpatient and insurance settings

Both roles involve reviewing medical necessity and appropriateness of care, but the Physician Assistant typically has a medical model training background, while the Nurse Practitioner has a nursing model. Both are vital in utilization review, with overlapping responsibilities and work environments.

What are some of the main challenges utilization review physician assistants face when transitioning from direct patient care to a review-focused role?

One of the main challenges Utilization Review Physician Assistants encounter is adapting to a predominantly administrative and analytical environment, as opposed to the hands-on patient care they may be accustomed to. The role requires interpreting clinical documentation, applying payer criteria, and making objective determinations about medical necessity, often with limited patient interaction. Additionally, there can be pressure to meet productivity targets and deadlines while maintaining accuracy and fairness in reviews. Collaboration with physicians, case managers, and insurance representatives is frequent, requiring strong communication and negotiation skills.
What are popular job titles related to Utilization Review Physician Assistant jobs in Riverside, CA? For Utilization Review Physician Assistant jobs in Riverside, CA, the most frequently searched job titles are:
What job categories do people searching Utilization Review Physician Assistant jobs in Riverside, CA look for? The top searched job categories for Utilization Review Physician Assistant jobs in Riverside, CA are:
What cities near Riverside, CA are hiring for Utilization Review Physician Assistant jobs? Cities near Riverside, CA with the most Utilization Review Physician Assistant job openings:
Utilization Review Physician Assistant jobs near you
Infographic showing various Utilization Review Physician Assistant job openings in Riverside, CA as of August 2026, with employment types broken down into 50% Full Time, and 50% Contract. Highlights an 100% In-person job distribution, with an average salary of $145,939 per year, or $70.2 per hour.

Utilization Review Nurse

Medix

Orange, CA • On-site

$38 - $53/hr

Full-time

Medical, Dental, Vision, Retirement

Re-posted yesterday

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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