Utilization Management Nurse Jobs in California
Utilization management nurse jobs in California are among the most active in the country, concentrated in managed care organizations, large integrated health systems, and health insurance carriers, with openings at every level from case management coordinators through senior UM nurse leads and directors. The highest volumes of listings come out of Los Angeles, San Francisco, and Sacramento, where employers such as Kaiser Permanente, Anthem Blue Cross of California, and Sutter Health consistently hire for these roles. The most in-demand specialties are behavioral health utilization review, Medicare and Medi-Cal managed care, and acute inpatient clinical review. Find a role that fits below and apply directly.
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Showing 5 of 14+ Utilization Management Nurse jobs
INTRODUCTION
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
ROLE AND RESPONSIBILITIES
The Utilization Management Nurse Lead is responsible for reviewing requests for inpatient and prior authorization services for all plan members. Works in collaboration with UM leaders and providers to ensure timely processing of referrals to provide the highest quality medical outcomes at the appropriate level of care. Oversees supports the team of UM Nurses with clinical decision-making tasks related to processing UM’s clinical referrals.
Schedule: Monday - Friday, 8:00 AM - 5:00 PM Pacific Time
Job Duties / Responsibilities:
-
Reviews reporting to assign tasks to UM Nurses for completion of time sensitive items.
-
Works closely as a liaison between management and the team to ensure that new cases assigned are worked in a timely manner.
-
Participates in department quality audits and vendor audits to assess timeliness of cases.
-
Effectively communicates and keeps the Utilization Management leadership team informed of all departmental operations, activities, data, program performance, issues or any other pertinent information that would impact the overall program compliance or achievement of internal goals.
-
Assists with team coverage plans as needed. Including jumping into operational support/work queues when needed.
-
Collaborates with other leaders in the department to develop and improve processes and workflows.
-
Acts as a resource to the team, members, providers, and community partners.
-
Establishes and maintains effective interpersonal relationships with staff at all levels, providers, other departments, or programs.
-
Leads, initiates and follows through on multiple projects simultaneously in a team environment.
-
Lead Responsibilities:
- Onboarding & training of new hires, including live training sessions and presentations
- Mentors, trains, audits and coaches a team of UM Nurses to ensure compliance with Alignment policies and procedures and all regulatory requirements.
- Serves as first-line SME/resource for inpatient UM questions
- Provides 1:1 coaching/shadowing support when needed
- Available and approachable/supportive while still helping to maintain accountability
- Provides guidance to staff or directly manages complicated requests from members, providers, or staff.
-
Other duties as assigned.
Job Requirements
Experience:
Required:
- Minimum of (3) consecutive years of related experience in concurrent review and/or prior authorization at managed care organization.
- Minimum (2) years of experience using MCG
Preferred:
- Prior leadership experience preferred
Education:
Required:
- Successful completion of an accredited Licensed Vocational Nursing or Registered Nursing Program
Specialized Skills:
Required:
- Knowledge of Medicare Managed Care Manuals and CMS regulatory requirements.
- Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
- Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
- Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly
- Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
- Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
- Report Analysis Skills: Comprehend and analyze statistical reports.
Licensure:
Required:
- Must have and maintain an active, valid, and unrestricted LVN or RN license in California (Non-Compact)
- Immediately upon hire, must be willing to obtain LVN and / or RN licensure in Nevada, (Non-compact), Arizona (Compact), North Carolina (Compact), and Texas (Compact) which will be reimbursed by company.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
-
While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
-
The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
COMPENSATION
- Pay Range: $85,696.00 - $128,543.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.
INTRODUCTION
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
ROLE AND RESPONSIBILITIES
The Utilization Management Nurse Lead is responsible for reviewing requests for inpatient and prior authorization services for all plan members. Works in collaboration with UM leaders and providers to ensure timely processing of referrals to provide the highest quality medical outcomes at the appropriate level of care. Oversees supports the team of UM Nurses with clinical decision-making tasks related to processing UM’s clinical referrals.
Schedule: Monday - Friday, 8:00 AM - 5:00 PM Pacific Time
Job Duties / Responsibilities:
-
Reviews reporting to assign tasks to UM Nurses for completion of time sensitive items.
-
Works closely as a liaison between management and the team to ensure that new cases assigned are worked in a timely manner.
-
Participates in department quality audits and vendor audits to assess timeliness of cases.
-
Effectively communicates and keeps the Utilization Management leadership team informed of all departmental operations, activities, data, program performance, issues or any other pertinent information that would impact the overall program compliance or achievement of internal goals.
-
Assists with team coverage plans as needed. Including jumping into operational support/work queues when needed.
-
Collaborates with other leaders in the department to develop and improve processes and workflows.
-
Acts as a resource to the team, members, providers, and community partners.
-
Establishes and maintains effective interpersonal relationships with staff at all levels, providers, other departments, or programs.
-
Leads, initiates and follows through on multiple projects simultaneously in a team environment.
-
Lead Responsibilities:
- Onboarding & training of new hires, including live training sessions and presentations
- Mentors, trains, audits and coaches a team of UM Nurses to ensure compliance with Alignment policies and procedures and all regulatory requirements.
- Serves as first-line SME/resource for inpatient UM questions
- Provides 1:1 coaching/shadowing support when needed
- Available and approachable/supportive while still helping to maintain accountability
- Provides guidance to staff or directly manages complicated requests from members, providers, or staff.
-
Other duties as assigned.
Job Requirements
Experience:
Required:
- Minimum of (3) consecutive years of related experience in concurrent review and/or prior authorization at managed care organization.
- Minimum (2) years of experience using MCG
Preferred:
- Prior leadership experience preferred
Education:
Required:
- Successful completion of an accredited Licensed Vocational Nursing or Registered Nursing Program
Specialized Skills:
Required:
- Knowledge of Medicare Managed Care Manuals and CMS regulatory requirements.
- Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
- Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
- Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly
- Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
- Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
- Report Analysis Skills: Comprehend and analyze statistical reports.
Licensure:
Required:
- Must have and maintain an active, valid, and unrestricted LVN or RN license in California (Non-Compact)
- Immediately upon hire, must be willing to obtain LVN and / or RN licensure in Nevada, (Non-compact), Arizona (Compact), North Carolina (Compact), and Texas (Compact) which will be reimbursed by company.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
-
While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
-
The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
COMPENSATION
- Pay Range: $85,696.00 - $128,543.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.
See All 14 Utilization Management Nurse Jobs in California
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Find JobsUtilization Management Nurse Jobs by City in California
Where California roles are concentrated, by current openings.
Utilization Management Nurse Job Market in California
A snapshot from current California openings, updated as new roles post.
Who's Hiring
- Alameda Health System3
- Alignment Healthcare3
- Bright Health Management2
- UCLA Health2
- Clever Care Health Plan1
Top Industries Hiring
- Insurance7
- Healthcare & Medical Services6
- Education2
- Non-Profit & Social Services1
What California Employers Look For
The qualifications that appear most often in utilization management nurse jobs across California.
- Active California Registered Nurse license issued by the California Board of Registered Nursing
- Minimum two years of acute care or managed care clinical nursing experience
- Working knowledge of InterQual or Milliman clinical decision-support criteria
- Familiarity with Medicare, Medi-Cal, or commercial managed care authorization processes
- Strong written communication skills for clinical documentation and denial letter writing
- Certification in case management such as CCM or CMCN preferred by most California employers
Utilization Management Nurse Jobs in California: Frequently Asked Questions
How do you become a utilization management nurse in California?
You must first hold an active Registered Nurse license issued by the California Board of Registered Nursing, which requires completing an accredited nursing program and passing the NCLEX-RN. From there, most California employers expect at least two years of clinical nursing experience before moving into a UM role. Adding a case management certification such as the CCM strengthens your candidacy, and many California health plans and hospital systems prefer candidates who have worked in acute care, med-surg, or a managed care setting beforehand.
Which companies hire utilization management nurses in California?
Employers hiring utilization management nurses in California right now include Alameda Health System, Alignment Healthcare, and Bright Health Management, based on current listings on Migrate Mate as of June 2026. California's large integrated health systems and managed care organizations account for most of the volume, reflecting the state's concentration of commercial and Medi-Cal health plan activity.
Which California cities have the most utilization management nurse jobs?
The cities with the most utilization management nurse openings in California are Los Angeles, Oakland, and Orange. Los Angeles leads because of its dense concentration of large health plans and hospital systems, while San Francisco and Sacramento reflect the headquarters presence of major managed care organizations and state government health programs such as Medi-Cal that drive steady UM staffing demand across Northern California.
Are there remote utilization management nurse jobs in California?
Yes, and more than most nursing roles. Utilization management is desk-based and chart-driven, which makes it well suited to remote and hybrid arrangements compared to bedside or procedural nursing. About 29% of utilization management nurse openings tied to California are remote or hybrid as of June 2026, reflecting how broadly California health plans have adopted distributed UM teams. Prior authorization review and concurrent inpatient reviews are the functions most commonly offered remotely.
How can I get hired as a utilization management nurse in California with little or no experience?
The most realistic entry path is moving from a clinical bedside role into a UM associate or clinical reviewer position within a large California health system or health plan. Kaiser Permanente and Sutter Health run internal transition programs that allow RNs from med-surg or case management to cross-train into utilization review. Starting as a care coordinator or discharge planner at a California acute care hospital builds the chart review and criteria application skills that UM teams prioritize. Holding an active California RN license and completing an introductory case management course gives candidates a clear edge when applying without direct UM experience.
Where can I find and apply to utilization management nurse jobs in California?
You can find and apply to utilization management nurse jobs in California on Migrate Mate, which lists current California openings. Search the listings to find roles that match your experience, specialization, and preferred location or work arrangement, then apply directly to the ones that fit.
See All 14 Utilization Management Nurse Jobs in California
Find roles in California that match your experience and apply in just a few clicks.
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