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Utilization Review Physician Jobs in Riverside, CA

ScionHealth

Inpatient Case Manager

Perris, CA · On-site

$49.83 - $63.20/hr

... utilization review and management, and discharge planning. Essential Functions Care Coordination * Coordinates clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians.

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 ...

UHS

CASE MANAGER (RN/LIC) - Full Time

Wildomar, CA

... 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 ...

VITAS Healthcare

Team Manager Inpatient

Irvine, CA · On-site

Collaborates with both the team physician and the attending physician regarding palliative care ... Performs utilization review of continuous care and inpatient levels of care for all patients on ...

UHS

LEAD RN- Full Time

Riverside, CA

$35.50 - $48/hr

Review patient medical record prior to visit to ensure chart readiness for physician. Interview ... Evaluates utilization of personnel, supplies, equipment and physical facilities for optimum ...

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

Utilization Review Physician information

See Riverside, CA salary details

$22

$44

$71

How much do utilization review physician jobs pay per hour?

As of Aug 19, 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.

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.

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.

Is utilization review a good job?

Utilization review physicians evaluate medical necessity and appropriateness of healthcare services, often working in insurance companies or healthcare organizations. The role typically requires strong clinical knowledge, attention to detail, and familiarity with medical guidelines, with schedules that can be regular or flexible depending on the employer. It can offer a stable career with opportunities for advancement and work-life balance, but job satisfaction depends on individual preferences and work environment.
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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:

What job categories do people searching Utilization Review Physician jobs in Riverside, CA look for?

The top searched job categories for Utilization Review Physician jobs in Riverside, CA are:

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 August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 3% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $91,752 per year, or $44.1 per hour.

Inpatient Case Manager

ScionHealth

Perris, CA • On-site

$49.83 - $63.20/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 2 days ago

ScionHealth rating

5.6

Company rating: 5.6 out of 10

Based on 49 frontline employees who took The Breakroom Quiz

802nd of 889 rated healthcare providers

Job description

Kindred Hospital Riverside is a 40-bed long-term acute care hospital offering the same in-depth care you would receive in a traditional hospital, but for an extended recovery period. We partner with your physician and offer 24-hour clinical care seven days a week so you can start your journey to wellness. For those who need special care, we offer an eight-bed ICU and one negative pressure room. We are located about 20 miles south east of downtown Riverside, in Perris; with easy driving access to a number of restaurants, grocers and shops.
Job Summary
Coordinates and facilitates the care of the patient population through effective collaboration and communication with the Interdisciplinary Care Transitions (ICT) team members. Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies. Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation and overall evaluation of individual patient needs. Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning.
Essential Functions
Care Coordination
  • Coordinates clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians.
  • Monitors all areas of patients' stay for effective care coordination and efficient care facilitation.
  • Remains current from a knowledge base perspective regarding reimbursement modalities, community resources, case management, psychosocial and legal issues that affect patients and providers of care.
  • Appropriately refers high risk patients who would benefit from additional support.
  • Serves as a patient advocate. Enhances a collaborative relationship to maximize the patient's and family's ability to make informed decisions.
  • Demonstrates knowledge of the principles of growth and development over the life span and the skills necessary to provide age appropriate care to the patient population served.
  • Participates in interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education and identified post hospital needs. Collaborates with clinical staff in the development and execution of the plan of care, and achievement of goals.
  • Coordinates with interdisciplinary care team, physicians, patients, families, post-acute providers, payors, and others in the planning of the patients' care throughout the care continuum.

Discharge Planning
  • Conducts comprehensive, ongoing assessment of patients to provide timely and safe discharge planning.
  • Provide comprehensive discharge planning for each patient. Utilizes critical thinking to develop and execute effective discharge planning.
  • Coordinate and communicates with patient/family efficient and effectively.

Utilization Management
  • Conducts medical necessity review for appropriate utilization of services from admission through discharge.
  • Promotes effective and efficient utilization of clinical resources.
  • Conducts timely and accurate clinical reviews, care collaboration and coordination of continued stay authorization with payor.

Other
  • Conducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
  • Serves on Hospital and Division committees when requested.

Knowledge/Skills/Abilities/Expectations
  • Knowledge of government and non-government payor practices, regulations, standards and reimbursement.
  • Knowledge of Medicare benefits and insurance processes and contracts.
  • Knowledge of accreditation standards and compliance requirements.
  • Ability to demonstrate critical thinking, appropriate prioritization and time management skills.
  • Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software.
  • Excellent interpersonal, verbal and written skills in order to communicate effectively and to obtain cooperation/collaboration from hospital leadership, as well as physicians, payors and other external customers
  • Demonstrates good interpersonal skills when working or interacting with patients, their families and other staff members.
  • Approximate percent of time required to travel: 0%
  • Must read, write and speak fluent English.
  • Must have good and regular attendance.
  • Performs other related duties as assigned.

Pay range: $49.83 - $63.20/Hr
ScionHealth has a comprehensive benefits package for benefit-eligible employees that includes Medical, Dental, Vision, 401(k), FSA/HSA, Life Insurance, Paid Time Off, and Wellness.
Qualifications
Education
  • Graduate of an accredited program required for RN.
  • BSN preferred or MSW/BSW with licensure as required by state regulations

Licenses/Certifications
  • Healthcare professional licensure required as Registered Nurse, or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) if required by state regulations.
  • Certification in Case Management a plus.

Experience
  • Two years of experience in a healthcare setting preferred.
  • Prefer prior experience in case management, utilization review, or discharge planning.

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