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

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 ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...

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 ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...

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 ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...

Astrana Health, Inc.

UM Review Nurse

Monterey Park, CA · Remote

$34 - $47/hr

Description Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position, you will utilize your clinical judgement to approve or ...

Astrana Health, Inc.

UM Review Nurse

Monterey Park, CA · On-site +1

$34 - $47/hr

Phillip Vasquez Compensation: $34.00 - $47.00 / hour Description Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position, you ...

Astrana Health

UM Review Nurse

Monterey Park, CA · Remote

$34 - $47/hr

Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position, you will utilize your clinical judgement to approve or deny outpatient ...

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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.

Coordinator, Office Utilization Review (FT, Days) Monterey Park Hospital

AHMC Healthcare

Whittier, CA • On-site

$26.28 - $32.30/hr

Full-time

Posted 28 days ago

AHMC Healthcare rating

7.1

Company rating: 7.1 out of 10

Based on 14 frontline employees who took The Breakroom Quiz

Job description

Monterey Park Hospital, a 101-acute care facility located in the San Gabriel Valley of Los Angeles County, is seeking an Office Coordinator for our Utilization Review Department. This is a full-time, 8-hour day shift position reporting to the Chief Operating Officer. 


The Utilization Review (UR) Office Coordinator is responsible for administrative duties and for assisting case managers with the daily operations of the department. The UR Office Coordinator processes all new patient admissions by preparing case reviews, including patient insurance information, for our Case Managers. The UR Office Coordinator prints the daily census to ensure proper caseload distribution and prepares Treatment Authorization Requests (TARs) for all medical inpatients as required. Additional responsibilities include:
  • Preparing, logging and faxing all TARS according to hospital guidelines, including notifying physicians of medical denials, processing deferred TARS, communicating with a medical nurse reviewer and making copies of medical documents for TAR review.
  • Communicates with IPAs and management companies regarding out-of-network capitated business and documents all communications.
  • Assists in collecting data relevant to patient discharge and helps coordinate nursing facility placements as directed by the Case Managers.
  • Performs other clerical duties as needed within the department, including answering and screening phone calls and taking department meeting minutes.
  • Communicates via phone with health plan/medical group case managers/coordinators regarding discharge planning and coordination. 
  • Arranges outpatient follow-up appointments for patients prior to discharge when needed.
  • Assists in arranging hospice referrals, home health referrals, and durable medical equipment (DME). 
  • Coordinates ambulance transportation for patient discharges.

  1. Knowledge in Google Workspace (Docs, Sheets, etc.) preferred. 
  2. 2 years of experience in an acute care setting (i.e., Admitting, Medical Records, Business Office) preferred. 

What AHMC Healthcare employees say

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Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

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About AHMC Healthcare

Sourced by ZipRecruiter

Caring for you and your loved ones is our top priority. We encourage our patients to be involved in the care process, and to communicate with our staff about their experience. From our admitting staff, to nurses, patient experience managers, and administration - we're here because we care. Physicians and facility staff are dedicated to achieving the highest level of clinical excellence. AHMC Healthcare hospitals have advanced diagnostics tools such as the MRI GE Signa HDxt1.5TMR system and the Toshiba Aquilon 128-slice CT scanner. Anaheim Regional Medical Center's Heart Center has the second largest volume of open heart surgeries in Orange County. Members of our Nursing staff have been recognized at the Hospital Heroes Awards and the SeniorServ Senior Care Hero Awards. Whichever AHMC Healthcare hospital you choose, you will be choosing a facility dedicated to delivering quality service and care.

Company size

5,001 - 10,000 Employees

Headquarters location

Alhambra, CA, US

Year founded

2004

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