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

The Hume Center

Psychiatric Nurse Practitioner

Antioch, CA · On-site

$82.66 - $117.10/hr

... Registered Nursing. * Certification as a Psychiatric Mental Health Nurse Practitioner (PMHNP). * Current DEA registration and CURES (Controlled Substance Utilization Review and Evaluation System ...

The Hume Center

Psychiatric Nurse Practitioner

Antioch, CA · On-site

$136K - $173K/yr

... Registered Nursing. * Certification as a Psychiatric Mental Health Nurse Practitioner (PMHNP). * Current DEA registration and CURES (Controlled Substance Utilization Review and Evaluation System ...

Sutter Health

Care Manager II, Acute

Modesto, CA · On-site

$82.48 - $115.46/hr

... Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely ... Comprehensive knowledge of Utilization Review, levels of care, and observation status. Awareness of ...

Sutter Health

Care Manager II, Acute

Modesto, CA

$82.48 - $115.46/hr

... Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely ... Comprehensive knowledge of Utilization Review, levels of care, and observation status. Awareness of ...

Sutter Health

Care Manager II, Acute

Modesto, CA · On-site

$82.48 - $115.46/hr

... Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely ... Comprehensive knowledge of Utilization Review, levels of care, and observation status. Awareness of ...

Sutter Health

Care Manager II, Acute

Modesto, CA · On-site

$82.48 - $115.46/hr

... Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely ... Comprehensive knowledge of Utilization Review, levels of care, and observation status. Awareness of ...

Sutter Health

Care Manager II, Acute

Antioch, CA

$90.58 - $126.81/hr

... Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely ... Comprehensive knowledge of Utilization Review, levels of care, and observation status. * Awareness ...

HiredFirst

RN - Case Mgmt.

Lodi, CA · On-site

$2.4K - $2.7K/wk

RN - Case Management (Contract) * Location: California 95240 * Contract Length: 13 Weeks * Pay: $2 ... Review resource utilization, length of stay, and discharge plans with providers * Manage complex ...

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Utilization Review Rn information

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$44

$72

How much do utilization review rn jobs pay per hour?

As of Aug 28, 2026, the average hourly pay for utilization review rn in Stockton, CA is $44.54, according to ZipRecruiter salary data. Most workers in this role earn between $35.19 and $51.15 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 Stockton, CA?

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

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

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

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

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

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

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Stockton, CA as of August 2026, with employment types broken down into 7% Internship, 79% Full Time, 7% Part Time, and 7% Contract. Highlights an 93% In-person, and 7% Remote job distribution, with an average salary of $92,638 per year, or $44.5 per hour.

Utilization Management Nurse, Senior

Blue Shield of CA

Lodi, CA • On-site

Other

Re-posted 15 days ago

Job description

Your Role

The Utilization Management team independently manages complex utilization and retrospective clinical reviews across multiple lines of business, assessing medical necessity, coding accuracy, treatment plans, discharge planning, and compliance requirements while supporting clinical consistency, process improvement, quality, timeliness, and appropriate escalation of high-risk cases.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

  • Associate Degree in Nursing required
  • Bachelor of Science in Nursing or advanced degree is preferred
  • 5 years of prior relevant experience managed care environment or clinical setting
  • Maintain active, unrestricted RN License in assigned states or the ability to obtain required state (in addition to primary state license) RN license within 90 days of hire

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.

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