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Utilization Review Jobs in Rialto, CA (NOW HIRING)

Prime Staffing

Travel RN Case Manager

Orange, CA · On-site

Strong assessment, discharge planning, and utilization review skills Description: The RN Case Manager coordinates patient care plans and services across the continuum of care. Works closely with ...

Discovery Behavioral Health

Clinical Director

Orange, CA · On-site

$100K - $120K/yr

Completes utilization reviews, oversees primary therapist process of utilization review and assists in the process of assuring that all patient stays are authorized (i.e. insurance, private pay, etc.

High Care Palliative

Be Seen First

Nurse Practitioner - Home Setting

Menifee, CA · On-site

$150K - $160K/yr

Participating in utilization review and quality assurance activities, including chart review and audits, and resolving physician's assistant conflicts. * Compassionate and caring demeanor * Excellent ...

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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.

LVN Discharge Planner

Care Navigators On Demand

Ontario, CA • On-site

$25 - $28/hr

Full-time

Re-posted 18 days ago

Job description


Under the direction of the Inpatient Review Nurse Manager and Supervisor, the incumbent will work with their respective Team Centers, that may include a Concurrent Review Nurse and Inpatient Coordinator, along with hospitals and IPAs, to initiate coordinated and continuous cost- effective discharge planning to ensure the continuity Member's care needs are met timely and readmission prevention is anticipated for IEHP Members.
Major Functions (Duties and Responsibilities)
1. Responsible for assisting with data collection for utilization review, including, but not limited to Member specific needs for daily review in anticipation of discharge needs within 24 hours of admission.
2. Responsible for the arrangement of transitions to lower or higher level of care and assists with transfer orders as needed.
3. Responsible for authorizations for outpatient services or ancillary services in preparation for the Member's discharge including, but not limited to home care, home therapies and durable medical equipment.
4. Responsible for ensuring that discharge needs for Member's include referring Members to Health Management, Health Education, Care Management, Behavioral Health or other internal or external programs as needed.
5. Anticipates and acts upon barriers to ensure effective Member progression by identifying clinical, operational, financial, and social issues that may affect patient outcomes and provides recommendation to the Concurrent Review Nurse for collaboration in an effort to assist Members with adhering to treatment plans and goals.
6. Responsible for assisting Team Center with the identification of Members who are at risk for extended lengths of stay, readmission, high utilization and/or complex discharge needs within the LVN scope of practice.5. Responsible for timely compliance and completion of cases as required by regulatory requirements.6. Responsible for working with other Team Members, departments, IPAs and the facilities to support the goals of the department as well as strategic priorities and vision of the organization.
Requirements
  • Minimum of 1 year of direct experience.
  • Valid LVN license

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