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

Serene Health

RN Case Manager

San Diego, CA · On-site

$90K - $110K/yr

Develop, review, and clinically approve individualized ECM care plans. * Identify and monitor clinical and utilization risks impacting member outcomes. * Provide RN clinical oversight and guidance to ...

Exceptionally Me Inc

Registered Nurse RN

Ramona, CA · On-site

$65 - $70/hr

Review Medication Administration Records (MARs) and other medication documentation for accuracy and ... Qualifications Active California Registered Nurse (RN) license in good standing. Minimum of 2 years ...

Exceptionally Me Inc

Registered Nurse RN

Ramona, CA · On-site

$65 - $70/hr

Review Medication Administration Records (MARs) and other medication documentation for accuracy and ... Active California Registered Nurse (RN) license in good standing. * Minimum of 2 years of Medical ...

Ageless Men's Health

Registered Nurse (RN)

Carlsbad, CA · On-site

$47/hr

Registered Nurse (RN) - Men's Health Clinic | Ageless Men's Health Location: Carlsbad, CA Schedule ... Performing patient assessments, reviewing medical histories, and documenting care in the EMR.

Ageless Mens Health

Registered Nurse (RN)

Carlsbad, CA · On-site

$47/hr

Registered Nurse (RN) - Men's Health Clinic | Ageless Men's Health Location: Carlsbad, CA Schedule ... Performing patient assessments, reviewing medical histories, and documenting care in the EMR.

Ageless Mens Health

Registered Nurse (RN)

Carlsbad, CA · On-site

$47/hr

Registered Nurse (RN) - Men's Health Clinic | Ageless Men's Health Location: Carlsbad, CA Schedule ... Performing patient assessments, reviewing medical histories, and documenting care in the EMR.

Trice Healthcare

Registered Nurse

La Jolla, CA · On-site

Orthopedic PCU Registered Nurse Relocation Assistance Provided - #####K plus ##### per mile (Max of ... Selected candidate may be hired at the CNIII level pending review and approval by the Nurse ...

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Utilization Review Rn information

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$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.

RN Case Manager

Serene Health

San Diego, CA • On-site

$90K - $110K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 28 days ago

Job description

Empowering Wellness, Transforming Lives
Optima Medical Management Group is dedicated to enhancing the quality of life by promoting wellness. At Optima MMG and all of its divisions: Serene Health, Community Support, and American TrueCare, our mission is to provide comprehensive support and care that not only addresses immediate concerns but also fosters long-term well-being.
As pioneers in the field, we aspire to lead in member care outcomes and set new standards for excellence and innovation. We are committed to empowering our members to achieve self-sufficiency in health, creating a ripple effect that strengthens families and communities.
Our work culture at Optima MMG is built on pride, passion, and a collective commitment to making a positive difference in people's lives. Our team members are dedicated problem-solvers who bring their unique skills and perspectives to the table. We believe that by fostering a collaborative and supportive environment, we can unlock the full potential of our team and, in turn, provide the best possible care to our members.
A career at Optima MMG is an opportunity to be part of a dynamic and forward-thinking organization. We encourage continuous learning and professional growth, providing our employees with access to industry experts, cutting-edge technologies, and a supportive community that values each individual's contributions. Join us on this journey to not only advance your career but to be a driving force in transforming lives and communities through passionate and fulfilling work!
Job Summary:
The RN Clinical Case Manager provides clinical assessment, care plan development, and ongoing clinical oversight within the Enhanced Care Management (ECM) program.
This is a non-bedside, RN-led role. The RN Clinical Case Manager serves as the clinical authority for ECM care planning, ensuring medical appropriateness, risk identification, and regulatory compliance. The RN works in close collaboration with ECM Lead Care Managers, who are responsible for care coordination, member engagement, and non-clinical assessments.
Core Responsibilities:
  • Conduct clinical assessments based on medical history, diagnoses, utilization patterns, medications, and risk indicators.
  • Develop, review, and clinically approve individualized ECM care plans.
  • Identify and monitor clinical and utilization risks impacting member outcomes.
  • Provide RN clinical oversight and guidance to ECM Lead Care Managers executing care plans.
  • Review medication lists for safety concerns, adherence issues, and escalation needs.
  • Collaborate with primary care providers, behavioral health clinicians, and internal care teams.
  • Support transitions of care following emergency department visits, hospitalizations, or other significant events.
  • Ensure care plans are updated based on changes in clinical status or utilization patterns.
  • Ensure care plans and clinical documentation meet Medi-Cal, CalAIM, and ECM program requirements.
  • Participate in audits, chart reviews, and quality improvement initiatives.
  • Provide clinical education and consultation to ECM staff as needed.
  • Contribute to the development and refinement of clinical workflows, tools, and best practices.
  • Maintain timely, accurate, and compliant clinical documentation.
  • Prepare clinical summaries, care plan updates, and progress notes.
  • Support internal reporting related to member outcomes, utilization, and care plan progress.
  • Performs other duties as assigned.

Required Qualifications:
  • Active California RN license.
  • Associate Degree in Nursing (ADN) required; BSN preferred.
  • Minimum 3 years of clinical nursing experience.
  • Experience working with Medi-Cal and/or managed care populations.
  • Strong clinical judgment and communication skills.
  • Ability to work independently and collaboratively.

Preferred Qualifications
  • Bilingual English/Spanish
  • Case management or utilization management experience.
  • Familiarity with Enhanced Care Management (ECM) or Health Home programs.
  • Experience supporting audits or regulatory reviews.
  • Training in Motivational Interviewing or trauma-informed care.

Physical Requirements:
  • Prolonged periods of computer-based work.
  • Ability to lift 10 pounds.
  • Flexibility to support program operations.

Pay range
$90,000-$110,000 USD
Benefits
Our full-time employees are eligible for the following benefits enrollment after 60 days of employment:
Medical, Dental, & Vision Benefits: We have various insurance options for you and your family.
Short & Long-Term Disability Benefits: Protection when you need it most.
Voluntary Accident, Voluntary Critical Illness, and Voluntary Hospital Indemnity Plans: Added security for you and your loved ones.
Flexible Spending Accounts: Manage your finances with flexibility.
Employee Assistance Program (EAP): Support when life throws challenges your way.
401(K): Building your financial future with us. Effective after 1 year of employment.
Paid Vacation and Sick Leave: Flexibility for the planned and unplanned.
Paid Holidays: Quality time to enjoy celebrations.
Employee Referral Program: Share the opportunities and reap the rewards.
Company Discount Program: Enjoy savings on everyday expenses and memberships.
Equal Employment Opportunity
Optima Medical Management Group and its divisions are an Equal Opportunity Employer. Optima MMG is committed to providing employment opportunities for all qualified candidates without discrimination on the basis of race, religion, sex, sexual orientation, gender identity, age, national origin, citizenship, disability, marital status, veteran status, or any other characteristic protected by federal, state or local laws. Optima MMG is committed to providing reasonable accommodation for individuals with disabilities.
Pre-Employment
Optima Medical Management Group is a drug-free workplace. Employment is contingent upon a successful pre-employment drug screening and background check.

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