ZipRecruiter

Log In

1

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

next page

Showing results 1-20

All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Carlsbad, CA

Utilization Review Rn information

See Carlsbad, CA salary details

$22

$43

$71

How much do utilization review rn jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for utilization review rn in Carlsbad, CA is $43.86, according to ZipRecruiter salary data. Most workers in this role earn between $34.66 and $50.38 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 Carlsbad, CA? The most popular types of Utilization Review Rn jobs in Carlsbad, CA are:
What are popular job titles related to Utilization Review Rn jobs in Carlsbad, CA? For Utilization Review Rn jobs in Carlsbad, CA, the most frequently searched job titles are:
What cities near Carlsbad, CA are hiring for Utilization Review Rn jobs? Cities near Carlsbad, CA with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Carlsbad, CA as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 15% Part Time, and 3% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $91,232 per year, or $43.9 per hour.

Utilization Review Quality Improvement

GovernmentJobs.com

San Diego, CA • On-site

Other

This job post has expired today. Applications are no longer accepted.

Job description

Job Summary

Behavioral Health Services (BHS) is currently accepting applications for the position of Utilization Review Quality Improvement Specialist (RN, LCSW, LMFT, LPCC, Clinical Psych). Interviews will take place the week of September 8, 2026. Job offers for selected candidates will be made the week of September 14, 2026. The starting salary for this position will be based on the candidate's qualifications at time of appointment. Future Salary Increases June 2027 – 4.73% increase to base pay (3.0% Across-the-Board +1.73% Market Adjustment)

Utilization Review Quality Improvement Specialists chart and interpret medical records for utilization review and reviews medical records for medical necessity and Medi-Cal compliance in County operated inpatient, outpatient, day treatment, and contracted facilities. The current vacancy is in Behavioral Health Services Administration located at 3255 Camino del Rio South, San Diego; however, the list established from this recruitment may be used to fill future vacancies in other departments. The Utilization Review Quality Improvement Specialist position has three options where focus is on either the quality management of mental health programs OR substance use disorders (SUD) programs OR Network Quality and Planning Team. Read the Utilization Review Quality Improvement Specialist job description, including minimum qualifications and essential functions.

***Effective September 9, 2022, this hard to recruit position qualifies for the Employee Referral Reward Program. If a current County of San Diego employee referred you to apply for this position, please indicate the employee's name on your job application in the space provided. ***

Hiring Process and Timeline

  • Job Offer and Background Process begins after week of September 14, 2026. Note: Current County employees may be excluded from additional background screening.
  • Pre-employment Medical Screening: Approximately 3 days following successful background investigation results.
  • Anticipated Start Date: Start date will be based upon successful completion of medical screening or other mutually agreed upon date.

Minimum Qualifications Required Education and Experience:

  1. Current valid California license as a Registered Nurse, Licensed Clinical Social Worker, Licensed Marriage Family Therapist, Licensed Professional Clinical Counselor, or Licensed Clinical Psychologist is required at time of application and must be maintained throughout employment; AND,
  2. One (1) year of recent, licensed clinical experience in an acute care psychiatric hospital or outpatient facility performing the duties of a Registered Nurse, Licensed Clinical Social Worker, Licensed Marriage Family Therapist, Licensed Professional Clinical Counselor, Licensed Clinical Psychologist, or related profession where duties included charting and interpreting medical records for the purpose of utilization review.

Note: Quality improvement, utilization review, peer review, or other chart review experience is highly desirable. The ideal candidate will:

  • Have knowledge and experience in electronic health records and training
  • Possess strong clinical and analytical skills, be detail oriented, and have excellent customer service skills
  • Work well independently and within a team, and speak in front of groups
  • Have the ability to analyze complex information and problems, and the ability to apply critical thinking to solve complex problems.
  • Have knowledge of federal and state regulations regarding the delivery of mental health, and alcohol and drug services to the County of San Diego Behavioral Health System of Care.
  • Have knowledge of quality improvement practices in order to implement quality improvement processes; ability to understand and interpret policies and procedures.
  • Be well organized and adaptive to fluctuating workload assignments and a positive attitude in their work style in order to accomplish the goals of the Quality Improvement Unit.

Blind Applicant Screening

The Department of Human Resources removes personally identifiable information from all recruitments. This practice, called Blind Applicant Screening, hides a candidate's personal information that could influence or bias a hiring decision. Personal information includes name, phone number, address, gender, age and race. This process helps contribute to a fair and equitable selection process leading to a more diverse and inclusive workforce.

The most highly qualified candidates, based on the evaluation results, will be referred for an interview. Be sure to include your experience in meeting the minimum requirements in both the Work Experience section and the Supplemental Questionnaire section of the Application.

Resumes will not be accepted in lieu of the application Work History and/or supplemental questionnaire.

Condition of Employment

As part of the County of San Diego's pre-employment process, prospective candidates will undergo a background check (including fingerprinting) and a pre-employment medical screening prior to beginning County employment. Additional types of background investigations may be conducted based on the job-related activities of the position. Current County employees may be excluded from this process.

Evaluation

The names of qualified applicants will be placed on a six (6) month employment list based upon scores received during the evaluation of information contained in their employment application and supplemental application questionnaire. Please ensure all information is complete and accurate, as the responses you provide on the supplemental application questionnaire will be reviewed using an automated evaluation system. If you are successful in the initial screening process, your application will be reviewed individually to confirm that the information you provided is accurate and qualifying.

Accommodation Reasonable accommodation may be made to enable qualified individuals with disabilities to perform the essential functions of a job, on a case-by-case basis.

The County of San Diego is an organization committed to veteran hiring, retention, and professional development. We recognize the contributions and sacrifices made by our veterans and value the unique expertise and leadership qualities they bring to our workforce. We strive to provide veterans with the resources and tools necessary to maximize their employment opportunities, and to assist veterans with their transition into civilian life by applying the valuable skills, knowledge and training acquired in service to positions and career paths at all levels within our large organization.

The County of San Diego is committed to valuing diversity and practicing inclusion because our diverse workforce is our greatest asset and our customers are our number one priority.

Apply