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

GQR

RN - Case Manager

San Francisco, CA · On-site

$2.5K - $2.6K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: San Francisco, California Start Date: September 8, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay ...

GQR

RN - Case Manager

Oakland, CA · On-site

$2.5K - $2.6K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Oakland, California Start Date: July 27, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay: $2557 ...

Acadia Healthcare

Director of Utilization

San Rafael, CA · On-site

$105K - $130K/yr

Collaborates with physicians, therapist and nursing staff to provide optimal review based on ... If applicable, current licensure as an LPN or RN within the state where the facility provides ...

Bayside Marin

Director of Utilization

San Rafael, CA · On-site

$105K - $130K/yr

Collaborates with physicians, therapist and nursing staff to provide optimal review based on ... If applicable, current licensure as an LPN or RN within the state where the facility provides ...

Acadia Healthcare

Director of Utilization

San Rafael, CA · On-site

$105K - $130K/yr

Collaborates with physicians, therapist and nursing staff to provide optimal review based on ... If applicable, current licensure as an LPN or RN within the state where the facility provides ...

GQR Healthcare

Travel RN Case Manager

Oakland, CA · On-site

$2.5K - $2.6K/wk

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Oakland, California Start Date: July 27, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay ...

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Utilization Review Rn information

See Fairfield, CA salary details

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$43

$70

How much do utilization review rn jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for utilization review rn in Fairfield, CA is $43.03, according to ZipRecruiter salary data. Most workers in this role earn between $33.99 and $49.42 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 Fairfield, CA? The most popular types of Utilization Review Rn jobs in Fairfield, CA are:
What are popular job titles related to Utilization Review Rn jobs in Fairfield, CA? For Utilization Review Rn jobs in Fairfield, CA, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Fairfield, CA look for? The top searched job categories for Utilization Review Rn jobs in Fairfield, CA are:
What cities near Fairfield, CA are hiring for Utilization Review Rn jobs? Cities near Fairfield, CA with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Fairfield, CA as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, and 4% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $89,502 per year, or $43 per hour.

Utilization Review RN (Hybrid)

Vivo HealthStaff

Oakland, CA • On-site

Full-time

Re-posted 26 days ago

Job description

Vivo HealthStaff is searching for a Utilization Review RN for a hybrid position for a health plan in San Francisco. It is a hybrid position with 1-2 days per week on-site required.Collaborates with the physician, nurse case manager, social worker, and other members of the health care team to meet individualized patient outcomes. Performs concurrent, and retrospective medical record reviews based on approved screening criteria, knowledge of insurance coverage, and communication with the third-party payers. Ensures medical necessity determinations, service authorization and concurrent denials are managed effectively and financially responsibly.EducationValid RN license in State of CaliforniaBachelor's degree in NursingExperienceClinical experience in acute care setting RequiredExperience with interqual and millimen PreferredLicenses and CertificationsCPR - Cardiac Pulmonary Resuscitation CPR/BLS Preferred andCCM - Certified Case Manager CCM Preferred andACMA PreferredKnowledge, Skills, and AbilitiesVerbal and written communication skills.Basic computer skills.Diagnostic and problem-solving skills.Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.Actively participates in ongoing professional enrichment and educational opportunities. Collaborates with and assists the nurse case manager and social worker to meet the patients' continuing health needs in a high quality, cost effective manner. Participates in planning rounds as needed to address and communicate issues related to acuity level of patient, LOS insurance and discharge needs.Collects quality improvement data in accordance with approved indicators. Recognizes potential problems and makes referrals to quality improvement, risk management, safety, infection control, and other departments as appropriate.Confers and collaborates routinely with the physician advisor, division chiefs, and attending physicians to resolve problems regarding acuity and level of care.Evaluates concurrent and retrospective denials for appeal opportunities. May generate appeal letters based on knowledge of clinical severity and intensity.Identifies insurance information, obtains authorization, communicates with financial counseling and assigns appropriate length of stay for admission.Implements strategies to avoid denials including potential denial notification to attending physician. Issues letter of non-coverage for Medicare or third party payers according to policies and procedures. Communicates utilization plans to case management team.Performs admission reviews and subsequent concurrent reviews to determine the necessity for acute care by application of accepted criteria based on age specific needs. Interacts with and assists third party payer reviewers to facilitate appropriate care and ensure payment for services. Performs concurrent and retrospective reviews telephonically as required. Completes all forms and documentation necessary to support appropriate utilization of resources.Serves as a resource to all staff in areas of utilization review/management. Educates members of health care team through in-services, staff meetings, orientation and formal educational offerings.Demonstrates knowledge of the dynamics of abuse/neglect, including identification and reporting laws. Coordinates with investigating law enforcement, protection agencies, hospital security, risk management, and healthcare team. Demonstrates knowledge of community resources serving the high social risk populations.Performs other duties as assigned.
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About Vivo HealthStaff

Sourced by ZipRecruiter

Vivo HealthStaff provides permanent recruitment services for both clinical and administrative positions in the healthcare sector. Over the past 2 years, our clients have seen a 98% retention rate with Vivo HealthStaff placements.

Industry

Health care and social assistance

Company size

11 - 50 Employees

Headquarters location

Dublin, CA, US

Year founded

2016

Social media

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