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

Medlivo

Travel RN Case Manager

Carmichael, CA · On-site

Medlivo is seeking a travel nurse RN Acute Care Case Management for a travel nursing job in ... Both Utilization Review and Discharge Planning Required; InterQual Experience Preferred but ...

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Utilization Review Rn information

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How much do utilization review rn jobs pay per hour?

As of Aug 23, 2026, the average hourly pay for utilization review rn in Roseville, CA is $44.32, according to ZipRecruiter salary data. Most workers in this role earn between $35.05 and $50.91 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 Roseville, CA?

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

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

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The top searched job categories for Utilization Review Rn jobs in Roseville, CA are:

What cities near Roseville, CA are hiring for Utilization Review Rn jobs?

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

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Roseville, CA as of August 2026, with employment types broken down into 5% Internship, 69% Full Time, 5% Part Time, and 21% Contract. Highlights an 84% In-person, and 16% Remote job distribution, with an average salary of $92,191 per year, or $44.3 per hour.

Health Care Professional - Utilization Review / First-Level Reviewer

Encompass Health Solutions, Inc

Sacramento, CA • Remote

$42 - $45/hr

Full-time

Posted 4 days ago

Job description

About Encompass

Encompass Workers' Comp Solutions is seeking a California-licensed healthcare professional to join our Utilization Review team as a Health Care Professional (HCP) / First-Level Reviewer.


This position may be filled by aLicensed Vocational Nurse (LVN), Registered Nurse (RN), or Doctor of Chiropractic (DC) with an active, unrestricted California license.


Founded by workers' compensation industry veterans, Encompass is committed to delivering objective, clinically sound services while fostering a professional, supportive, and employee-centered workplace.


About the Position

The Health Care Professional performs first-level utilization review of treatment authorization requests for injured workers. The HCP reviews clinical documentation and applies California's Medical Treatment Utilization Schedule (MTUS) and other applicable evidence-based guidelines to determine whether requested treatment meets criteria for authorization.


The HCP may approve treatment requests when applicable criteria are satisfied. Requests that cannot be approved at first-level review are prepared and referred to the appropriate Physician Reviewer.


The HCP does not modify or deny Requests for Authorization. All modification and denial decisions are made by Physician Reviewers.


What You'll Do

  • Review Requests for Authorization and supporting medical documentation for completeness.
  • Apply MTUS and other applicable evidence-based clinical guidelines.
  • Determine whether sufficient clinical information is available to complete the review and request additional information when necessary.
  • Make first-level review determinations within applicable regulatory timeframes.
  • Approve treatment requests when applicable criteria are satisfied.
  • Communicate professionally with requesting providers to obtain additional information and discuss treatment requests as appropriate.
  • Prepare and refer cases that cannot be approved at first-level review to the appropriate Physician Reviewer.
  • Review additional medical information received in connection with reconsiderations.
  • Identify and appropriately process duplicate Requests for Authorization.
  • Maintain accurate and timely documentation of utilization review activity.
  • Ensure required communications and regulatory timeframes are met.
  • Manage multiple reviews, priorities, and deadlines in a fast-paced remote work environment.


Required Qualifications

  • Active, unrestricted California professional license as an LVN, RN, or DC.
  • Must reside and work in California.
  • Clinical experience relevant to your licensed discipline and the clinical services being reviewed. Three or more years of relevant clinical experience is preferred.
  • Strong clinical assessment, critical-thinking, analytical, and problem-solving skills.
  • Excellent written and verbal communication skills.
  • Strong attention to detail, organization, and time-management skills.
  • Ability to work independently and manage multiple priorities and deadlines.
  • Ability to navigate multiple software systems concurrently.
  • Proficiency with Microsoft Office and web-based platforms.
  • Minimum typing speed of 45 WPM.
  • Ability to perform extensive telephone- and computer-based work.


Preferred Qualifications

  • Previous workers' compensation experience.
  • Previous utilization review or utilization management experience.
  • Experience in occupational medicine, orthopedics, neurology, rehabilitation, musculoskeletal care, acute care, case management, occupational health, disability management, or another relevant clinical specialty.
  • Familiarity with MTUS and evidence-based treatment guidelines.
  • Relevant professional certification or advanced credential appropriate to your discipline.


Schedule & Work Environment

  • Full-time
  • Monday-Friday during standard business hours
  • Home-based/remote position
  • Must work from within California
  • Hourly, non-exempt
  • Overtime eligible in accordance with applicable California law


Compensation

$42.00-$45.00 per hour

The compensation range reflects the responsibilities and requirements of the Health Care Professional/First-Level Reviewer position. Actual starting compensation within the range will be based on relevant utilization review and workers' compensation experience, clinical experience, qualifications, certifications, and other job-related factors.


Why Encompass?

This is an opportunity to use your clinical experience in a different way-helping facilitate timely, medically appropriate treatment decisions for injured workers while working in a structured, professional, home-based environment.

At Encompass, we value clinical integrity, accuracy, professionalism, and doing the right thing for our clients, providers, injured workers, and employees.


Equal Employment Opportunity

Encompass Health Solutions is an Equal Opportunity Employer. We are committed to maintaining a workplace free from discrimination and harassment in compliance with applicable federal, state, and local laws. Employment decisions are made without regard to race, color, religion, sex, gender identity, sexual orientation, age, national origin, disability, veteran status, marital status, or any other characteristic protected by law.

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