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Utilization Review Jobs in California, MD (NOW HIRING)

The Orchards

Social Services Manager

Great Mills, MD · On-site

Attends meetings with other staff to discuss residents and to participate in care planning, restorative care planning, discharge planning, utilization review, falls, obtain/order DME when appropriate ...

The Orchards

Social Services Manager

Great Mills, MD

Attends meetings with other staff to discuss residents and to participate in care planning, restorative care planning, discharge planning, utilization review, falls, obtain/order DME when appropriate ...

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All JobsUtilization Review JobsUtilization Review Jobs in California, MD

Utilization Review information

See California, MD salary details

$20

$40

$66

How much do utilization review jobs pay per hour?

As of Aug 28, 2026, the average hourly pay for utilization review in California, MD is $40.52, according to ZipRecruiter salary data. Most workers in this role earn between $32.02 and $46.54 per hour, depending on experience, location, and employer.

What is a utilization review?

A Utilization Review (UR) job involves assessing the medical necessity, efficiency, and appropriateness of healthcare services. UR professionals, often nurses or healthcare specialists, review patient records, insurance claims, and treatment plans to ensure they meet industry standards and payer requirements. They work with healthcare providers, insurance companies, and regulatory agencies to optimize care while controlling costs. Their goal is to balance quality patient care with cost-effective resource utilization.

What does a utilization review do?

A typical day in Utilization Review involves reviewing patient medical records, evaluating the necessity and appropriateness of proposed treatments or services, and documenting recommendations based on clinical criteria and insurance policies. Utilization Review specialists often collaborate closely with physicians, nurses, and insurance representatives to gather additional information and clarify cases. While much of the role is desk-based and may include remote work options, it requires regular communication with both clinical and administrative teams. This position offers variety and challenge, as no two cases are exactly alike, and there are often opportunities to advance into supervisory or quality improvement roles within the department.

What are the key skills and qualifications needed to thrive in utilization review?

To thrive in Utilization Review, professionals typically need a background in nursing or healthcare, strong clinical assessment capabilities, and a thorough understanding of medical guidelines and insurance regulations. Familiarity with electronic medical records (EMR) systems and utilization management software, and often certification such as Certified Utilization Review Specialist (CURN), are important. Excellent critical thinking, attention to detail, and strong communication skills enable effective case evaluation and collaboration with healthcare teams. These skills and qualifications ensure objective, accurate decisions that support cost-effective, quality patient care within compliance standards.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare or related degree such as nursing, health administration, or social work is required. Certification in case management or utilization review, like the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects, and strong analytical and communication skills are essential for success in the role.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, often under strict deadlines and documentation requirements. The job can be stressful due to high workload, the need for accuracy, and managing complex cases, but stress levels vary based on work environment and individual coping skills.

What are popular job titles related to Utilization Review jobs in California, MD?

For Utilization Review jobs in California, MD, the most frequently searched job titles are:

What job categories do people searching Utilization Review jobs in California, MD look for?

The top searched job categories for Utilization Review jobs in California, MD are:

What cities near California, MD are hiring for Utilization Review jobs?

Cities near California, MD with the most Utilization Review job openings:

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in California, MD as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 16% Part Time, 2% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $84,278 per year, or $40.5 per hour.

APPEALS COORDINATOR

Calvert Health System

Prince Frederick, MD • On-site

$23 - $28.75/hr

Part-time

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

  • JOB DESCRIPTION DETAILS
    • Job Summary:
      • Responsible for the management and communication of denials/appeals received from third party payers, managed care companies, and/or government entities related to medical necessity and/or level of care. This associate will be a liaison and point of contact for clinical denials and appeal inquiries. The Appeals Coordinator will review each case identified/referred for appeal based on Milliman Care Guidelines (MCG) or InterQual guidelines, determine the viability of the appeal, and manage the appeal process. The RN Clinical Appeals Nurse will actively manage, maintain and communicate denial/appeal activity to appropriate stakeholders, and report suspected or emerging trends related to payer denials. Working with department leaders, this individual will coordinate education and other performance improvement initiatives to mitigate lost revenue related to medical necessity denials. Key Performance and trends related to denials/appeals will be reported to the facility.
    • Education:
      • Position requires a Bachelor's degree and Registered Nurse Licensure.
    • Registration/Certification/Licensure:
      • State Registered Nurse Licensure
    • Experience:
      • Minimum 3+ year's experience in Utilization Review and/or Case Management,  and 3 years in a clinical setting.
    • Other Requirements:
      • Maintains unit-specific and hospital competencies, mandatory learning, and any clinical certifications required in accordance with the Staff Education and Training policy GA-057 and/or any other department requirements.
      • Intermediate skill level on the computer: Office Products including Word, Excel, and PowerPoint.
      • Demonstrates skills in planning, organizing, and managing multiple functions and complex processes.
      • Competent in Joint Commission Standards, Federal and State requirements relating to required documentation for the electronic health record to maintain compliance.
      • Knowledge of revenue cycle operations including state and federal reimbursement policies

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