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 25+ Utilization Management Nurse jobs
This position operates on a hybrid work schedule. This position will require 3 days onsite at the Huntington Beach or Monrovia office.
Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.
Who Are We? ✨
Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values.
Why Join Us?
We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.
Job Summary
The UM Nurse I - RN performs clinical review of authorization requests to determine medical necessity based on established criteria, regulatory requirements, and organizational policies. This role conducts utilization review activities under established guidelines and escalates complex or non-standard determinations to senior staff or the Medical Director.
Functions & Job Responsibilities
- Conduct clinical review of prior authorization requests using approved criteria (e.g., MCG, InterQual).
- Review outpatient and routine inpatient requests.
- Ensure compliance with CMS, state, and contractual turnaround time requirements.
- Document medical necessity determinations clearly and accurately.
- Communicate authorization decisions to providers, members and internal teams.
- Identify cases requiring physician or Medical Director review.
- Participate in concurrent review and discharge planning coordination as assigned.
- Ensure compliance with regulatory timelines.
- Support audit readiness and documentation integrity.
- Additional duties as assigned.
Qualifications
Education and Experience
- Active, unrestricted RN license.
- Minimum of three (3) years of clinical experience.
- At least one (1) year in utilization management or case management preferred.
Skills
- Knowledge of medical necessity criteria (MCG/InterQual).
- Understanding of CMS/state UM regulations.
- Strong clinical assessment and documentation skills
- Ability to manage caseload efficiently.
- Effective provider communication.
- Bilingual proficiency in Cantonese, Mandarin, Spanish, Vietnamese, or Korean preferred.
Wage Range: $72,758/year to $89,128/year
Physical & Working Environment.
Physical requirements needed to perform the essential functions of the job, with or without reasonable accommodation:
- Must be able to travel when needed or required
- Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking)
- Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs. Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly. Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. May occasionally be required to work irregular hours based on the needs of the business.
Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.
This position operates on a hybrid work schedule. This position will require 3 days onsite at the Huntington Beach or Monrovia office.
Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.
Who Are We? ✨
Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values.
Why Join Us?
We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.
Job Summary
The UM Nurse I - RN performs clinical review of authorization requests to determine medical necessity based on established criteria, regulatory requirements, and organizational policies. This role conducts utilization review activities under established guidelines and escalates complex or non-standard determinations to senior staff or the Medical Director.
Functions & Job Responsibilities
- Conduct clinical review of prior authorization requests using approved criteria (e.g., MCG, InterQual).
- Review outpatient and routine inpatient requests.
- Ensure compliance with CMS, state, and contractual turnaround time requirements.
- Document medical necessity determinations clearly and accurately.
- Communicate authorization decisions to providers, members and internal teams.
- Identify cases requiring physician or Medical Director review.
- Participate in concurrent review and discharge planning coordination as assigned.
- Ensure compliance with regulatory timelines.
- Support audit readiness and documentation integrity.
- Additional duties as assigned.
Qualifications
Education and Experience
- Active, unrestricted RN license.
- Minimum of three (3) years of clinical experience.
- At least one (1) year in utilization management or case management preferred.
Skills
- Knowledge of medical necessity criteria (MCG/InterQual).
- Understanding of CMS/state UM regulations.
- Strong clinical assessment and documentation skills
- Ability to manage caseload efficiently.
- Effective provider communication.
- Bilingual proficiency in Cantonese, Mandarin, Spanish, Vietnamese, or Korean preferred.
Wage Range: $72,758/year to $89,128/year
Physical & Working Environment.
Physical requirements needed to perform the essential functions of the job, with or without reasonable accommodation:
- Must be able to travel when needed or required
- Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking)
- Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs. Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly. Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. May occasionally be required to work irregular hours based on the needs of the business.
Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.
See All 25 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
Top Industries Hiring
- Insurance
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 Blue Shield of California, Stanford Medicine Children's Health, and Packard Children’s Health Alliance, based on current listings on Migrate Mate as of October 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 Palo Alto, Long Beach, and Los Angeles. 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 75% of utilization management nurse openings tied to California are remote or hybrid as of October 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 25 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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