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Utilization Review Jobs in Merced, CA (NOW HIRING)

Nurse Liaison

Merced, CA ยท On-site

$53 - $56/hr

Review utilization patterns of individuals with high health care utilization to analyze medical factors leading to utilization and assist Care Management staff to implement interventions regarding ...

Nurse Liaison

Merced, CA ยท On-site

$53 - $56/hr

Review utilization patterns of individuals with high health care utilization to analyze medical factors leading to utilization and assist Care Management staff to implement interventions regarding ...

Review utilization patterns of individuals with high health care utilization to analyze medical factors leading to utilization and assist Care Management staff to implement interventions regarding ...

Consistently create a positive customer experience through the utilization of the sales and ... reviewing performance, and providing timely and relevant feedback. * Process Management: Take a ...

Showing results 41-60

Utilization Review information

See Merced, CA salary details

$22

$44

$72

How much do utilization review jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for utilization review in Merced, CA is $44.65, according to ZipRecruiter salary data. Most workers in this role earn between $35.29 and $51.30 per hour, depending on experience, location, and employer.

Is utilization review work from home?

Utilization review jobs can often be performed remotely, especially with the increased adoption of telecommuting in healthcare and insurance industries. Many employers offer work-from-home options, provided the reviewer has the necessary certifications and access to electronic health records or claims systems. However, some positions may require on-site presence for meetings or audits.

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.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, which can be stressful due to strict deadlines, high accuracy requirements, and the need to balance patient care with insurance policies. The job often requires strong attention to detail, communication skills, and the ability to handle complex cases under time pressure.

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 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, such as the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects. Relevant skills include knowledge of medical coding, insurance policies, and strong analytical abilities.

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

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

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

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

Infographic showing various Utilization Review job openings in Merced, CA as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $92,874 per year, or $44.7 per hour.

Physician - Primary Care Clinic

Community Health Centers of America

Gustine, CA โ€ข On-site

$300K - $350K/yr

Full-time, Part-time

Medical, Dental, Life, Retirement, PTO

Re-posted 5 days ago


Job description

Description:

Community Health Centers of America is hiring for an MD/DO to work in our family practice clinics in Gustine, CA. Must be willing to supervise NP/PAs. Possibly will also work in partner long-term care facilities. You will be responsible for diagnosing and treating patients in the clinic setting. Internal Medicine - Family Practice


Community Health Centers of America is a premier multi-specialty group focused on improving the health of the community through excellence in clinical care. Our goal is to provide better care to the patient with a collaborative, supportive, respectful, and productive work environment for its healthcare professionals.


Sign-On Bonus!


Job Description:

  • Helps patients by evaluating medical conditions.
  • Develops and implements treatment plans, including prescriptions.
  • Monitors and evaluates treatment results.
  • Evaluates patients by interviewing patient, family, and other persons; conducting physical examinations; observing behaviors; reviewing medical history and related documents; selecting, administering, and ordering laboratory tests and evaluating results.
  • Develops treatment plans by determining nature and extent of medical conditions.
  • Maintains interdisciplinary treatment by reviewing treatment plans and progress, and consulting and collaborating with primary care physicians, mental health therapists, nurses, and other health care providers.
  • Assures quality and safe service for patients and staff by enforcing policies, procedures, standards, rules, Joint Commission for Accreditation of Health Care Organizations requirements, and legal regulations; participating in utilization reviews; and remaining available for emergency consultations.
  • Maintains historical records by documenting symptoms, medications, and treatment events and writing summaries.
  • Updates job knowledge by participating in continuing medical educational opportunities, reading professional publications, maintaining personal networks, and participating in professional organizations.
  • Enhances department and organization reputation by accepting ownership for accomplishing new and different requests and exploring opportunities to add value to job accomplishments.

Job Qualifications:

  • Completion of residency
  • Valid state medical license as MD or DO
  • Valid DEA certificate
  • 3 years’ experience working as a Physician
  • Current BLS and/or ACLS

SKILLS

  • Excellent verbal and written communication
  • Critical thinking
  • Active listening
  • Social perceptiveness

Our healthcare professionals enjoy competitive benefits, including:

  • Highly competitive salaries with benefits, a 401(k) plan, and CME allowance
  • Sign-On Bonus!
  • Manageable work schedules, providers are not required to work evenings or weekends
  • Some flexibility with schedules - great for providers with families/other responsibilities
  • Night/Weekend call coverage!
  • Opportunity to work with a diverse range of professionals
  • A professionally challenging environment with a mix of disease acuity
  • A career with administrative freedom - appropriate support staff is supplied
  • Access to charting system that has been designed for quick and easy billing. Dictation available (including, but not limited to Dragon).

We are looking for skilled, self-motivated, and enthusiastic Providers. If you are interested, please submit your resume.


Job Types: Full-time, Part-time


Salary: $300,000.00 - $350,000.00 per year, depending on experience


Benefits:

  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Employee assistance program
  • Flexible schedule
  • Health insurance
  • Life insurance
  • Loan forgiveness
  • Malpractice insurance
  • Paid time off
  • Professional development assistance
  • Referral program
  • Relocation assistance
  • Visa sponsorship
  • Vision insurance

License/Certification:

  • California MD/DO license (Required)

Work Location: In person


Schedule:

  • Day shift
  • Monday to Friday
  • No nights
  • No weekends


Requirements:

POSITION REQUIREMENTS:

  • Must possess a degree in medicine and a valid license from the California Medical Board.
  • Experience: 3-5 years of related experience preferred; or equivalent combination of education and experience
  • Licenses/Certifications: Appropriate certifications and/or licensures
  • Current BLS/ACLS required
  • Current DEA required
  • In depth knowledge of legal medical guidelines and medicine best practices

SKILLS:

  • Excellent verbal and written communication
  • Active listening and active learning
  • Flexibility to work with a variety of people, differing in ages, personalities, and backgrounds
  • Time management skills to be able to see a high number of patients
  • Interpersonal skills, compassion, and empathy to build positive relationships with patients and colleagues
  • Critical thinking
  • Social perceptiveness
  • Complex problem solving
  • Respect patient confidentiality