ZipRecruiter

Log In

1

Utilization Review Rn Jobs in San Jose, CA (NOW HIRING)

Sutter Health

Utilization Review Tech III

San Mateo, CA · On-site

$48.91 - $68.47/hr

Graduate of an accredited Vocational Nursing Program * OR Other: Graduate of an accredited ... Critical thinking skills necessary to provide utilization review/discharge planning services ...

Sutter Health

Utilization Review Tech III

San Mateo, CA · On-site

$48.91 - $68.47/hr

Graduate of an accredited Vocational Nursing Program * OR Other: Graduate of an accredited ... Critical thinking skills necessary to provide utilization review/discharge planning services ...

Sutter Health

Utilization Review Tech III

San Mateo, CA · On-site

$48.91 - $68.47/hr

Graduate of an accredited Vocational Nursing Program * OR Other: Graduate of an accredited ... Critical thinking skills necessary to provide utilization review/discharge planning services ...

previous pagenext page

Showing results 21-40

All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in San Jose, CA

Utilization Review Rn information

See San Jose, CA salary details

$25

$49

$80

How much do utilization review rn jobs pay per hour?

As of Aug 28, 2026, the average hourly pay for utilization review rn in San Jose, CA is $49.55, according to ZipRecruiter salary data. Most workers in this role earn between $39.18 and $56.92 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 San Jose, CA?

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

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

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

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

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

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

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

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in San Jose, CA as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 18% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $103,072 per year, or $49.6 per hour.

Utilization Review/Case Management RN

Pyramid Consulting

Santa Clara, CA • On-site

$75 - $85/hr

Other

Medical, Dental, Vision, Retirement

Re-posted 4 days ago

Job description

Immediate need for a talented Utilization Review/Case Management RN. This is a 03+ Months Contract opportunity with long-term potential and is located in Santa Clara, CA (Onsite). Please review the job description below and contact me ASAP if you are interested.
Job ID:25-96149
Pay Range: $75 - $85/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:

  • Utilization Management:-Performs daily pre-admission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge.
  • Monitors the progression of the discharge plan and facilitates discussions with the multidisciplinary teams.
  • Educates other healthcare team members on utilization and care coordination.
  • Collaborates with and provides information to patients, families, physicians, and staff regarding the discharge plans and transitions.
  • Understands and consistently applies the interpretation, and utilization of member health care benefits.
  • Conducts UM, care coordination and discharge planning activities according to all applicable regulatory requirements.
  • Discharge Planning:- Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient.
  • Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social services, and other health care providers and agencies.
  • Regulatory:-Conducts UM, care coordination, and discharge planning activities according to all applicable regulatory requirements.
  • Shift Timings: 8:00 AM - 4:30 PM - 5 days/week including every other weekend (both Saturday & Sunday).
  • Days vary but we are looking for 2 travelers to fill the schedules below:
  • Traveler Week 1 Schedule Week 2 Schedule
  • Traveler 1 Mon, Tue, Wed, Fri, Sat Sun, Mon, Wed, Thu, Fri
  • Traveler 2 Mon, Tue, Thu, Fri, Sat Sun, Tue, Wed, Thu, Fri
Key Requirements and Technology Experience:
  • Skills-Recent hospital/acute care setting experience
  • Strong discharge planning background
  • Availability aligned with the outlined shift schedules
  • Minimum two (2) years of experience in utilization review, case management, and discharge planning.
  • Graduate of accredited school of nursing.
  • Diploma/Associate Degree in Nursing.
  • License, Certification, Registration:-Registered Nurse License (California) - Required upon hire.
  • Basic Life Support (BLS) - Required upon hire.
  • Knowledge of the Nurse Practice Act, TJC, DMHC, CMS, NCQA, HIPAA, ERISA, EMTALA & all other applicable federal/state/local laws & regulations.
  • Demonstrated strong communication and customer service skills, problem-solving, critical thinking, & clinical judgment abilities.
  • Fundamental word processing & computer navigation skills & the ability to interpret & use analytic data in day to day operations.
  • Knowledge of health care benefits associated with various business lines (Medicare/KPSA, Commercial/KFH, Medi-Cal, Federal, etc.).
  • Must be able to work in a Labor/Management Partnership environment.
  • Acute inpatient hospital-level experience.
  • Bachelor's degree in nursing or a health care related field preferred.
  • Master's degree in case management preferred.
Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.
#tel

Apply