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

Mercy General Hospital

Care Coordinator RN

Sacramento, CA · On-site

$74.56 - $90.51/hr

... utilization review and discharge planning processes. Job Requirements Required * Current California RN licensure * Minimum of two (2) years of acute hospital clinical experience or * A Master ...

Corvel

CA UR Case Manager II

Folsom, CA · Remote

$32.18 - $48.68/hr

... RN is required unless local state regulations permit LVN/LPN * 4 or more years of recent clinical experience * Prospective, concurrent, and retrospective utilization review experience preferred

InnovAge

Universal RN | Full Time

Sacramento, CA · On-site

$44.66 - $58.08/hr

Responsibilities The Universal RN (Registered Nurse) provides skilled nursing care in accordance ... Support utilization review, peer review, and quality management activities as assigned. Setting ...

InnovAge

Universal RN | Full Time

Sacramento, CA · On-site

$44.66 - $71.49/hr

Responsibilities The Universal RN (Registered Nurse) provides skilled nursing care in accordance ... Support utilization review, peer review, and quality management activities as assigned. Setting ...

InnovAge

Universal RN | Full Time

Sacramento, CA

$44.66 - $71.49/hr

Responsibilities The Universal RN (Registered Nurse) provides skilled nursing care in accordance ... Support utilization review, peer review, and quality management activities as assigned. Setting ...

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Utilization Review Rn information

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$22

$44

$72

How much do utilization review rn jobs pay per hour?

As of Sep 2, 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:

What are popular job titles related to Utilization Review Rn jobs in Roseville, CA?

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

What job categories do people searching Utilization Review Rn jobs in Roseville, CA look for?

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.

Care Manager, Registered Nurse, Emergency Department

Sutter Health

Roseville, CA • On-site

$82.48 - $115.46/hr

Full-time

Posted 21 days ago

Sutter Health rating

8.3

Company rating: 8.3 out of 10

Based on 330 frontline employees who took The Breakroom Quiz

40th of 898 rated healthcare providers

Job description

We are so glad you are interested in joining Sutter Health!
Organization:
SMCS-Valley Administration
Position Overview:
Responsible for Care Coordination and Care Transitions Planning throughout the acute care patient experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely progression and transition of patients to the appropriate level of care to prevent unnecessary admissions or readmissions. The Care Management process encompasses communication and facilitates care across the continuum through effective resource coordination. The goals of this role are to include the achievement of optimal health, access to care, and appropriate utilization of resources balanced with the patients' self -determination while coordinating in a timely and integrated fashion. He/She collaborates with patients, families, physicians, the interdisciplinary team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and community resources. If assigned to the Emergency Department, the Care Management process is to address complex clinical and social situations efficiently in order to avoid unnecessary admissions.
Job Description:
This position is Limited Term, up to 24 weeks and benefited.
EDUCATION:
  • Graduate of an accredited school of nursing

CERTIFICATION & LICENSURE:
  • RN-Registered Nurse of California Upon Hire

TYPICAL EXPERIENCE:
  • 2 years of experience in acute care case management or health plan case management/utilization management.

SKILLS AND KNOWLEDGE:
  • A broad knowledge base of health care delivery and case management within a managed care environment.
  • Comprehensive knowledge of Utilization Review, levels of care, and observation status.
  • Awareness of healthcare reimbursement systems: HMO, PPO, PPS, CMS, value-based reimbursement models, and alternative payment systems preferred.
  • Working knowledge of laws, regulations, and professional standards affecting case management practice in an integrated delivery system: including but not limited to: CMS, Title 22, CHA Consent Manual, CDPH and TJC.
  • A broad knowledge base of post-acute levels of care and associated regulatory compliance requirements.
  • General understanding of coding and DRG assignment process preferred.
  • Must be able to effectively communicate with, and promote cooperation and collaboration between individuals including patients/families/caretakers, physicians, nurses and other ancillary partners.
  • Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families.
  • Demonstrates commitment to service excellence in all patients, family and employee interactions and in performing all job responsibilities.
  • Functions in a manner to promote quality patient care and assure a positive patient experience.
  • Strong verbal and written communication skills and negotiation skills
  • Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities.
  • Intermediate computer and technology skills.
  • Ability to promote teamwork and to effectively function in teams.
  • Ability to interact effectively with key internal and external constituents using collaboration, and customer service skills that promote excellence in the patient experience.

#LI-DF1
Job Shift:
Nights
Schedule:
Full Time
Shift Hours:
12
Days of the Week:
Variable
Weekend Requirements:
One Weekend Shift a month
Benefits:
Yes
Unions:
No
Position Status:
Non-Exempt
Weekly Hours:
36
Employee Status:
Limited Term (Fixed Term)
Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
Pay Range is $82.48 to $115.46 / hour
The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate's experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health's comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.

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