ZipRecruiter

Log In

1

Utilization Review Jobs in Rialto, CA (NOW HIRING)

Prime Staffing

Travel Utilization Review RN

Orange, CA · On-site

Specialty: Utilization Review * Discipline: RN * Start Date: 09/21/2026 * Duration: 13 weeks * 40 hours per week * Shift: 8 hours * Employment Type: Travel About the Position Specialty: RN - ...

New

Assured Nursing

Travel Utilization Review RN

Orange, CA · On-site

Assured Nursing is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Orange, California. & Requirements * Specialty: Utilization Review * Discipline: RN * Start ...

New

Prime Healthcare

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

At least 3 years of experience in utilization review, referrals, authorizations, denials and appeals. * Current BCLS (AHA) certificate upon hire and maintain current. * Knowledge of MCG Criteria and ...

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · On-site

$30.64 - $45.80/hr

The Utilization Review Nurse gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and out-patient treatment, certifies the medical necessity ...

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · Remote

$30.64 - $45.80/hr

The Utilization Review Nurse gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and out-patient treatment, certifies the medical necessity ...

Acadia Healthcare

Utilization Specialist PRN

Riverside, CA · On-site

$31 - $50/hr

Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...

Pacific Grove

Utilization Specialist PRN

Riverside, CA · On-site

$31 - $50/hr

Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...

Acadia Healthcare

Utilization Specialist PRN

Riverside, CA · On-site

$31 - $50/hr

Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...

Medix

SNF Review Nurse (LVN or RN)

Orange, CA · On-site

$38 - $51/hr

Remote Utilization Management Nurse - RN/LVN Location: 100% Remote Schedule: Monday-Friday, 8:00 AM ... Conduct daily inpatient and concurrent reviews and coordinate appropriate levels of care.

next page

Showing results 1-20

All JobsUtilization Review JobsUtilization Review Jobs in Rialto, CA

Utilization Review information

See Rialto, CA salary details

$21

$42

$69

How much do utilization review jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for utilization review in Rialto, CA is $42.40, according to ZipRecruiter salary data. Most workers in this role earn between $33.51 and $48.70 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 the most commonly searched types of Utilization Review jobs in Rialto, CA?

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

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

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

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

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

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

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

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Rialto, CA as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 11% Part Time, 2% Contract, and 1% Nights. Highlights an 78% Physical, 2% Hybrid, and 20% Remote job distribution, with an average salary of $88,190 per year, or $42.4 per hour.

Utilization Review Technician III

Prime Healthcare Management Inc

Ontario, CA • On-site, Remote

$24.65 - $30.03/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 20 days ago

Key responsibilities

  • Coordinate the utilization review and appeals process, including phone calls, data entry, mailing/faxing appeals, and tracking data from insurance providers and health plans.

  • Document and track all communication attempts with insurance providers and health plans, and scan related correspondence to the EMR or tracking tools.

  • Follow up on denials and support the maintenance of government review audits and other payer audits as assigned.

Prime Healthcare rating

6.4

Company rating: 6.4 out of 10

Based on 289 frontline employees who took The Breakroom Quiz

650th of 898 rated healthcare providers

Job description

Overview

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation's leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team! 

Responsibilities

The Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. This position will also serve as a liaison and own the coordination with other UR techs in the team while being responsible for coordinating phone calls, data entry, mailing/faxing appeals and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals. Document and track all communication attempts with insurance providers and health plans and scan all related correspondence to the respective EMR/ tracking tool. Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers. The Utilization review tech will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned. UR tech III will also function as an SME to support the UR tech team and remote counter parts with the specific processes as applicable. The Utilization review tech will further support the department needs for Release of Information through faxing and mailing, discharge coordination or other duties as assigned.

Qualifications
  • Bachelor's degree or four years of relevant experience required.
  • Microsoft office proficiency.
  • Good communication skills

    • Preferred qualifications:

  • Completion of a medical terminology course; preferred.
  • Knowledge of HIPAA regulations preferred.
    • Pay Transparency

    Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $24.65 to $30.03. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

    Employment StatusFull TimeShiftDaysEqual Employment Opportunity

    Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

     Privacy Notice

    Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf

    Employment Type: FULL_TIME

    What Prime Healthcare employees say

    Pay

    Benefits

    Hours and flexibility

    Workplace

    Get the full story on Breakroom

    Apply