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Utilization Review Rn Jobs in Anaheim, CA (NOW HIRING)

Talencia

RN - Case Manager

San Pedro, CA · On-site

$68 - $72/hr

This role focuses on care coordination, utilization review, and discharge planning in an acute care setting. The RN Case Manager will manage a patient caseload, ensuring timely and appropriate care ...

Critical Connection

RN - Case Management

Orange, CA · On-site

$2.5K/wk

Active RN license * Case management or utilization review experience preferred Compensation & Benefits * Competitive weekly pay * Guaranteed hours * First-day medical, dental, and vision insurance

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Utilization Review Rn information

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$44

$72

How much do utilization review rn jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for utilization review rn in Anaheim, CA is $44.27, according to ZipRecruiter salary data. Most workers in this role earn between $35.00 and $50.82 per hour, depending on experience, location, and employer.

How does a utilization review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

What are the key skills and qualifications needed to thrive as a utilization review RN, and why are they important?

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

How to get into utilization review as a registered nurse?

To become a utilization review RN, you typically need a valid registered nurse license and experience in clinical settings. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or knowledge of medical coding and insurance processes can enhance your qualifications. Gaining experience in case management or health insurance companies can also improve your chances of entering the field.

What is the difference between Utilization Review Rn vs Case Manager?

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

What is a utilization review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.
What are the most commonly searched types of Utilization Review Rn jobs in Anaheim, CA? The most popular types of Utilization Review Rn jobs in Anaheim, CA are:
What are popular job titles related to Utilization Review Rn jobs in Anaheim, CA? For Utilization Review Rn jobs in Anaheim, CA, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Anaheim, CA look for? The top searched job categories for Utilization Review Rn jobs in Anaheim, CA are:
What cities near Anaheim, CA are hiring for Utilization Review Rn jobs? Cities near Anaheim, CA with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Anaheim, CA as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 16% Part Time, and 2% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $92,072 per year, or $44.3 per hour.

RN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr

Emanate Health

Covina, CA • On-site

$52.03 - $80.64/hr

Full-time

Re-posted 24 days ago

Emanate Health rating

7.2

Company rating: 7.2 out of 10

Based on 29 frontline employees who took The Breakroom Quiz

Job description

Current Emanate Health Employees - Please log into your Workday account to apply
Everyone at Emanate Health plays a vital role in the care we deliver. No matter what department you belong to, the work you do at Emanate Health affects lives. When you join Emanate Health, you become part of a team that works together to strengthen our communities and grow as individuals.
On Glassdoor's list of "Best Places to Work" in 2021, Emanate Health was named the #1 ranked health care system in the United States, and the #19 ranked company in the country.
Job Summary
The Utilization Review Nurse will evaluate medical records to determine medical necessity by applying clinical acumen and the appropriate application of policies and guidelines to urgent and standard reviews. You will document decisions using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings.
Job Requirements
Minimum Education Requirement :
Minimum Experience Requirement :
Minimum of three years of utilization management experience. Experience in quality- related job preferred. Computer proficiency is required. Excellent customer service skills required.
Minimum License Requirement :
California RN license.
Delivering world-class health care one patient at a time.
Pay Range:
$52.03 - $80.64

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