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Utilization Review Rn Jobs in Mission Viejo, CA (NOW HIRING)

Prime Healthcare

Utilization Review RN

Ontario, CA

$71K - $104K/yr

Minimum 3 years RN Utilization Manager working for a Health Plan. * At least 3 years of experience in utilization review, referrals, authorizations, denials and appeals. * Current BCLS (AHA ...

GQR Healthcare

Travel RN Case Manager

Orange, CA · On-site

$2.0K - $2.1K/wk

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Orange, California Start Date: September 21, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay ...

GQR Healthcare

Travel Case Manager RN

Mission Viejo, CA · On-site

$2.2K - $2.3K/wk

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Mission Viejo, California Start Date: September 21, 2026 Profession: Registered Nurse (RN) Facility:

New

GQR Healthcare

Travel Case Manager RN

Mission Viejo, CA · On-site

$2.1K - $2.2K/wk

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Mission Viejo, California Start Date: September 21, 2026 Profession: Registered Nurse (RN) Facility:

New

GQR Healthcare

Travel Case Manager RN

Mission Viejo, CA · On-site

$2.0K - $2.1K/wk

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Mission Viejo, California Start Date: September 21, 2026 Profession: Registered Nurse (RN) Facility:

New

GQR Healthcare

Travel Case Manager RN

Mission Viejo, CA · On-site

$2.2K - $2.3K/wk

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Mission Viejo, California Start Date: September 21, 2026 Profession: Registered Nurse (RN) Facility:

New

Pacific Grove

Utilization Specialist PRN

Riverside, CA

$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 ...

American Traveler

Travel RN Case Manager

Orange, CA · On-site

Case Management/Utilization Review role supporting Breast Cancer Screening and Breast nodule/mass ... Active CA RN license required in-hand at time of application (EMSA not accepted) * BLS ...

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Utilization Review Rn information

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How much do utilization review rn jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for utilization review rn in Mission Viejo, CA is $45.94, according to ZipRecruiter salary data. Most workers in this role earn between $36.30 and $52.74 per hour, depending on experience, location, and employer.

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.

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.

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.

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 case management certification can enhance job prospects, and familiarity with electronic health records (EHR) systems is often required.

What are the most commonly searched types of Utilization Review Rn jobs in Mission Viejo, CA?

The most popular types of Utilization Review Rn jobs in Mission Viejo, CA are:

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For Utilization Review Rn jobs in Mission Viejo, CA, the most frequently searched job titles are:

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Cities near Mission Viejo, CA with the most Utilization Review Rn job openings:

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Mission Viejo, CA as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 18% Part Time, 2% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $95,554 per year, or $45.9 per hour.

Utilization Review RN

KPC GLOBAL MEDICAL CENTERS INC.

Santa Ana, CA • On-site

$50 - $85/hr

Full-time

Posted yesterday

New

Job description

SUMMARY

The Utilization Review RN reviews client health records to ensure proper utilization of treatment resources.

RESPONSIBILITIES AND DUTIES:

  • Coordinates and reviews all medical records, as assigned to caseload.
  • Actively participates in Case Management and Treatment Team meetings
  • Serves as on-going educator to all departments.
  • Responsible for reviewing patient charts in order to assess whether the criteria for admission and continuation of treatment is being met; gathering data and responding to request for records from fiscal intermediary; gathering clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting
  • Able to work independently and use sound judgment.
  • Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment.
  • Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families.
  • Performs other duties as assigned.

This position is a mid-shift (3pm - 11:30pm) and will need to work on weekends.

EDUCATION & EXPERIENCE REQUIREMENTS:

  • Bachelor's or Master’s degree in social work, behavioral or mental health, nursing or other related health field preferred.
  • CA RN License Required
  • Minimum of 2 years' experience with the population of the facility and previous experience in utilization management preferred.

SKILLS & ABILITIES REQUIREMENTS:

  • Communication
  • Planning & Organizing
  • Problem Solving
  • Attention to Detail

PHYSICAL REQUIREMENTS:

  • Body Positions: Sitting and standing for prolonged periods.
  • Body Movements: Arm and hand dexterity.
  • Body Senses: Must have command of close and distant sight, color perception and hearing.
  • Strength: Ability to lift and move up to 25-pounds.

 

Working Environment:

  • Work in an office, where the climate is controlled.
  • OSHA exposure category: I
  1. Category I – Position includes tasks that involve exposure to Blood borne Pathogens.
  2. Category II – Position includes tasks that do not have exposure to Bloodborne Pathogens, however employment may require unplanned Category I tasks.
  3. Category III – Positions includes tasks that do not involve exposure to Bloodborne Pathogens.  This position would not be required to perform Category I tasks.
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About KPC Health

Sourced by ZipRecruiter

KPC Health has an integrated approach to serving the people of Riverside, San Bernardino and Orange County. Our acute care medical centers provide high quality, comprehensive and affordable healthcare for the entire family. For us, healthcare is not just about caring for our patients, but also about investing in the people throughout our communities. We are one team with one mission and that mission is for all our patients, and their families to Enjoy Life in Great Health.

Industry

Health care and social assistance

Company size

201 - 500 Employees

Headquarters location

Santa Ana, CA, US

Year founded

2004

Social media

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