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Utilization Review Physician Jobs in Riverside, CA

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 ...

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 ...

Oso Home Care

Authorization Specialist

Irvine, CA · On-site

$21 - $25.90/hr

... and utilization review nurses. * Respond to requests for additional information. * Participate in peer-to-peer review coordination when requested by physicians. * Escalate complex authorization ...

Oso Home Care

Authorization Specialist

Irvine, CA · On-site

$21 - $25.90/hr

... and utilization review nurses. * Respond to requests for additional information. * Participate in peer-to-peer review coordination when requested by physicians. * Escalate complex authorization ...

KPC Health

RN Case Manager (PD-Days)

Santa Ana, CA · On-site

Collaborates with the patient and their families, the patient's physicians, and all care providers ... UTILIZATION REVIEW AND DISCHARGE PLANNING * CA RN LICENSE & BLS CARD from American Heart Assoc. ...

UHS

CASE MANAGER (RN/LIC) - Full Time

Wildomar, CA · On-site

... physicians. Rancho Springs Hospital also provides the area's only OB/Emergency Department program ... Two (2) years' experience clinical Case Management or Utilization Review preferred Completion of an ...

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How much do utilization review physician jobs pay per hour?

As of Jul 29, 2026, the average hourly pay for utilization review physician 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 is a Utilization Review Physician?

A Utilization Review Physician is a medical doctor who evaluates the necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities. They review patient medical records, treatment plans, and insurance policies to ensure that the care provided meets established guidelines and is medically necessary. Their work helps healthcare organizations and insurance companies manage costs while ensuring patients receive proper care. Utilization Review Physicians often collaborate with healthcare providers and insurance representatives to make coverage and care decisions. They play a critical role in maintaining quality standards in healthcare delivery.

What Does a Utilization Review Physician Do?

A utilization review physician depresses healthcare costs and prevents medical resource overuse. You typically work with health insurance companies to review claims or pre-authorization requests submitted by other doctors. Your other responsibilities include informing doctors of the reasons for coverage refusal, whether it be for treatment, medication, or another request. You write medical review reports, ensure requests fit the patient’s coverage or insurance plan, ensure medical necessity for hospitalization incidents, perform pharmaceutical reviews, schedule independent medical examinations, and make sure that prescribed drugs are truly necessary. You may also work for a disability insurance company to determine the qualifications regarding payouts.

What is the difference between Utilization Review Physician vs Medical Director?

AspectUtilization Review PhysicianMedical Director
CredentialsMedical degree, medical license, board certification in relevant specialtyMedical degree, medical license, often additional leadership or management certifications
Work EnvironmentHospitals, insurance companies, healthcare organizations, primarily review and evaluate patient casesHealthcare organizations, insurance companies, overseeing clinical operations and policy development
Employer & Industry UsageUsed in insurance, managed care, and healthcare facilities for utilization reviewUsed in healthcare organizations and insurance companies for leadership and policy oversight

The Utilization Review Physician focuses on evaluating patient cases to determine appropriate care and resource use, while the Medical Director oversees clinical policies and manages healthcare operations. Both roles require medical credentials, but the Medical Director often has additional leadership responsibilities.

How does a Utilization Review Physician typically interact with other healthcare professionals during the review process?

Utilization Review Physicians regularly collaborate with case managers, nurses, attending physicians, and insurance representatives to assess the medical necessity and appropriateness of patient care. They review clinical documentation, provide feedback, and may request additional information to ensure that care meets established guidelines. Clear communication and a collaborative approach are essential, as the role often involves discussing complex cases and educating clinical staff on best practices and compliance requirements.

What are the key skills and qualifications needed to thrive as a Utilization Review Physician, and why are they important?

To thrive as a Utilization Review Physician, you need a medical degree (MD or DO), board certification in a clinical specialty, and in-depth knowledge of evidence-based medicine and healthcare regulations. Familiarity with utilization management software, electronic health records (EHRs), and compliance standards such as CMS guidelines is crucial. Strong analytical skills, attention to detail, and effective communication are essential soft skills for reviewing cases and collaborating with healthcare teams. These competencies ensure accurate assessments, cost-effective care, and adherence to regulatory requirements in the healthcare system.
More about Utilization Review Physician jobs
What are the most commonly searched types of Utilization Review Physician jobs in Riverside, CA? The most popular types of Utilization Review Physician jobs in Riverside, CA are:
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What cities near Riverside, CA are hiring for Utilization Review Physician jobs? Cities near Riverside, CA with the most Utilization Review Physician job openings:
Utilization Review Physician jobs near you
Infographic showing various Utilization Review Physician job openings in Riverside, CA as of July 2026, with employment types broken down into 1% Locum Tenens, 2% As Needed, 86% Full Time, 9% Part Time, and 2% Contract. Highlights an 97% Physical, 1% Hybrid, and 2% Remote job distribution, with an average salary of $91,752 per year, or $44.1 per hour.

Utilization Review Technician III

Prime Healthcare Management Inc

Ontario, CA • On-site, Remote

$24.65 - $30.03/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 13 days ago

Prime Healthcare rating

6.4

Company rating: 6.4 out of 10

Based on 281 frontline employees who took The Breakroom Quiz

643rd of 890 rated healthcare providers

Job description

Overview

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation's leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team! 

Responsibilities

The Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. This position will also serve as a liaison and own the coordination with other UR techs in the team while being responsible for coordinating phone calls, data entry, mailing/faxing appeals and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals. Document and track all communication attempts with insurance providers and health plans and scan all related correspondence to the respective EMR/ tracking tool. Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers. The Utilization review tech will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned. UR tech III will also function as an SME to support the UR tech team and remote counter parts with the specific processes as applicable. The Utilization review tech will further support the department needs for Release of Information through faxing and mailing, discharge coordination or other duties as assigned.

Qualifications
  • Bachelor's degree or four years of relevant experience required.
  • Microsoft office proficiency.
  • Good communication skills

    • Preferred qualifications:

  • Completion of a medical terminology course; preferred.
  • Knowledge of HIPAA regulations preferred.
    • Pay Transparency

    Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $24.65 to $30.03. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

    Employment StatusFull TimeShiftDaysEqual Employment Opportunity

    Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

     Privacy Notice

    Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf

    Employment Type: FULL_TIME

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