Utilization Review RN

primehealthcare· RN
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📍 Ontario, CA, USFULL TIME💰 USD 72K–104K

About this role

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

Responsible for the quality and resource management of all authorizations and referrals with the Prime Healthcare Employee EPO. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive review of the medical record for the medical necessity, intensity of service and severity of illness.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

 

Required qualifications:

  • Minimum 7 years Post Graduate of an accredited school of nursing and a current state Registered Nurse license.
  • Minimum 3 years RN Utilization Manager working for a Health Plan.
  • 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/or InterQual Criteria required.
  • Experience and knowledge in basic to intermediate computer skills.

    • Preferred qualifications:

  • Five years acute care nursing experience preferred.
  • Experience with self-funded health plan 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.  Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary.  A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $71,760.00 to $104,000.00 on an annualized basis. 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 Status

    Full Time

    Shift

    Days

    Equal 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

     

    Frequently Asked Questions

    What is the salary for the Utilization Review RN role at primehealthcare?
    The listed salary for this Utilization Review RN position at primehealthcare is USD 72K–104K. This is an FULL TIME role.
    Where is the Utilization Review RN position at primehealthcare located?
    This Utilization Review RN role at primehealthcare is based in Ontario, CA, US. The position is listed as on-site or hybrid. Check the full job description or apply directly to confirm the work arrangement.
    Is the Utilization Review RN role at primehealthcare full-time or part-time?
    This is listed as a FULL TIME position. It is posted as a Utilization Review RN role in the RN department at primehealthcare.
    Which team or department does the Utilization Review RN at primehealthcare belong to?
    This Utilization Review RN position is part of the RN department at primehealthcare. See the full job description for more information about the team structure and responsibilities.
    How do I apply for the Utilization Review RN position at primehealthcare?
    Click the "Apply Now" button on this page. You will be redirected to primehealthcare's official application portal hosted on icims where you can submit your application directly.
    When was the Utilization Review RN job at primehealthcare posted?
    This Utilization Review RN position at primehealthcare was posted on Jul 30, 2026. Apply as soon as possible — early applications are often reviewed first.
    Utilization Review RN
    primehealthcare · 💰 USD 72K–104K
    Apply for this role ↗

    You'll be redirected to primehealthcare's official application page on icims.