Utilization Review Technician - UR Case Management

Salary : $49,255.80 - $63,558.80 Annually
Location : Moreno Valley
Job Type: Regular
Job Number: 26-73981-01
Department: RUHS-Medical Center
Opening Date: 02/13/2026
Closing Date: 2/18/2026 7:00 AM Pacific

ABOUT THE POSITION
The County of Riverside's - RUHS-Medical Center Department is seeking a Utilization Review Technician to support the UR Case Management Division in Moreno Valley.

Under general supervision, performs a variety of clerical and data collection tasks and acts as a liaison between providers, medical staff and insurance plans in support of Utilization Management and professional staff of Riverside University Health System (RUHS); performs other related duties as required.

The Utilization Review Technician is a journey level classification and reports to an appropriate supervisory or manager level position. Incumbents respond to inquiries and concerns of the health plan members and is the primary liaison between the health plan member and network providers. In addition, this class monitors patient treatment records and follows up with physicians or nursing staff to ensure that documentation is provided or a determination is made as to medical necessity and appropriateness of services.

Essential Duties include the following:

• General office and administrative support
• Inventory control and purchasing
• Scheduling and timekeeping
• Other duties as assigned

Desired Qualifications:

• Microsoft 365 proficiency (Word, Excel, Teams)
• Strong organizational skills

Work Schedule: Will be discussed during the interview; Tentative 5/40, 8:00 AM - 4:30 PM, rotating weekends and holidays required.

Meet the Team!
Every day at Riverside University Health System Medical Center, a dedicated team of healthcare professionals and support staff come together to improve lives across Riverside County. Our nationally recognized programs and specialized services thrive because of the diverse talents and commitment of our team members. No matter your background or skill set, you'll discover meaningful opportunities and a strong sense of purpose here.

To learn more about RUHS Medical Center, please visit

EXAMPLES OF ESSENTIAL DUTIES
Record intake information on the phone from providers requesting referral and/or authorization and refer requests to nursing staff and/or Medical Director, or give authorization according to specified criteria following physician or nursing staff directions.
Monitor and maintain Medi-CAL Treatment Authorization Requests (TARs) backlog and Commercial Insurance backlog; refer TARs to Case Manager for resubmission.
Act as a liaison and resource to other departments, contracted hospitals, insurance companies, subsidized programs, etc. relative to the work of the department.
Monitor insurance listed within patients Emergency Medical Records (EMR) and notify Integrated Care Management (ICM) team members regarding insurance changes; assist in obtaining authorizations and approval for inpatient stays and document authorizations in the EMR.
Work with medical staff to complete patient charts and forms; compare medical record documentation with professional standards of care, as outlined by the utilization review nurse manager or physician.
Issue Important Message (IM) and Medicare Outpatient Observation Notice (MOON) letters for Medicare beneficiaries.
Coordinate Durable Medical Equipment (DME) prescriptions with RUHS staff and insurance companies/payor source.
Monitor and maintain California Children Services (CCS) database document authorizations/denials from CCS and make referrals for all patients under 21 with qualifying CCS diagnosis.
Promote continuity of care by transmitting all Discharge Summaries to insurance providers.
MINIMUM QUALIFICATIONS
OPTION I

Education: Graduation from high school or attainment of a satisfactory score on a G.E.D test.
Experience: Six months of clinical, billing, or medical office administration experience in a healthcare or a Health Maintenance Organization.
OPTION II

Education: Graduation from high school or attainment of a satisfactory score on a G.E.D test.
Experience: One year of clerical experience.

Knowledge of: General policies of health coverage limits related to managed care and HMO standards; hospital registration, reimbursement or referral practices and procedures; eligibility requirements of subsidiary programs such as Managed Care, Medi-Cal, Medicare, CCS, etc.; general interviewing techniques and telephone etiquette; computer programs, including use of database and word processing; proper English usage, style, grammar, punctuation, and spelling.

Ability to: Learn specialized medical terminology, project indicators and office procedures; perform a variety of clerical duties and work effectively under stressful conditions; communicate effectively in providing information and assisting the public; interact with public service providers, members of the public and staff in a courteous, effective manner.
SUPPLEMENTAL INFORMATION
Please Note: Due to the high volume of applications received, this posting may close earlier than the listed deadline. Candidates are encouraged to apply as soon as possible.

For additional information or questions regarding this recruitment, contact Anay Sanchez at or 951.955.5893.
APPLICATION INFORMATION

Veteran's Preference
The County has a Veterans Preference Policy applicable to new hires. To qualify, upload a copy of your (or your spouse's) Member-4 Form DD-214 indicating dates of service, and a copy of your spouse's letter of disability (if applicable) with your application. For privacy reasons, it is recommended that you remove your social security information from the document(s). A Human Resources Representative will review the materials and determine if you qualify for veterans' preference. The Veterans Preference Policy, C-3 is available here:
Reasonable Accommodations
The County of Riverside is committed to providing reasonable accommodation to applicants as required by the Americans with Disabilities Act (ADA) and Fair Employment and Housing Act (FEHA). Qualified individuals with disabilities who need a reasonable accommodation during the application or selection process should contact the recruiter for the position noted above. For additional information and/or to obtain the appropriate form for requesting a reasonable accommodation, please visit the Disability Access Office web page located at:
Proof of Education
If using education to qualify or when requested by the recruiter, upload a copy of any license(s), official/unofficial transcript(s), degrees, and/or related employment documents to your NeoGov account at the time of application and before the closing date. Official or unofficial transcripts will be accepted.

If your education was completed outside of the United States, you will need to provide a copy of your Foreign Education Equivalency evaluation from a member of the National Association of Credential Evaluation Services () or Association of International Credential Evaluators, Inc. ().
Work Authorization Requirement
Applicants must be legally authorized to work in the United States at the time of application. The County of Riverside does not participate in visa sponsorship programs, including H1-B visas, and will not provide sponsorship for any employment-based visas.
Equal Opportunity Employer
The County of Riverside is an Equal Opportunity Employer. It is the policy of the County of Riverside to provide equal employment opportunities for all qualified persons. All applicants will be considered without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender, gender identity, gender expression, marital status, ancestry, medical condition (cancer and genetic characteristics), genetic information, or denial of medical and family care leave, or any other non-job-related factors.
Pre-Employment
All employment offers are contingent upon successful completion of pre-employment requirements including a criminal background investigation, which involves fingerprinting. (A felony or misdemeanor conviction may disqualify the applicant from County employment). A pre-employment physical examination and background check may be required.
Probationary Period
As an Approved Local Merit System, all County of Riverside employees, except those serving "At Will," are subject to the probationary period provisions as specified in the applicable Memorandum of Understanding, County Resolution, or Salary Ordinance. Temporary and Per Diem employees serve at the pleasure of the agency/department head.
General Information
Current County of Riverside and/or current employees of the hiring department may receive priority consideration. Qualified candidates may be considered for future County vacancies.
Job postings may close without notice based on application volume. Submit your complete application by the recruitment close date; no late applications are accepted. Ensure all relevant experience/education is reflected on your application/resume, as a failure to demonstrate position requirements may disqualify applicants. A description of job duties directly copied from the job classification or job posting will not be considered.
Please read and follow any special application instructions on this posting. Click the 'Apply' link located on this page to submit your application. For additional instructions on the application process, examinations, Veteran's preference, pre-employment accommodation or other employment questions, please refer to our web site,
If you are experiencing technical problems, you may contact the applicant support desk Monday through Friday, 6 am to 5 pm Pacific Time at support@ or toll-free 1-855-524-5627.
BENEFIT PROGRAM: UPE.
MEDICAL/DENTAL/VISION INSURANCE: A choice of different medical, dental and visions plan are available to elect. The County provides a Flexible Benefit Credit contribution as governed by the applicable LIUNA Memorandum of Understanding to contribute towards the cost of these plans.

Note: Employees on assignment through the Temporary Assignment Program (TAP) receive different benefits. See the list
MISCELLANEOUS RETIREMENT: County of Riverside has three retirement Tiers through the California Public Employees' Retirement System (CalPERS).

• Tier I (Classic Member - Formula 3% @ 60): Applicable to current and former County of Riverside local miscellaneous employees hired prior to 08/24/2012 and did not withdraw CalPERS contributions. The employee contribution is eight (8%) percent.
• Tier II (Classic Member - Formula 2% @ 60): Applicable to local miscellaneous employees 1) hired after 08/23/2012 through 12/31/2012; 2) Previously employed with another CalPERS contracting public agency or a reciprocal retirement system, with a break in service of less than six months between the separation date with the previous employer and the appointment date with the County of Riverside. The employee contribution is seven (7%) percent.
• Tier III (PEPRA New Member - Formula 2% @ 62): Applicable to CalPERS local miscellaneous new members hired on or after the implementation of the Public Employees' Pension Reform Act of 2013 (PEPRA) which took effect January 1, 2013. Effective July 1, 2023 employee contributions are 7.25% and will increase to 7.75% effective July 1, 2024.

A new member is defined as any of the following:

1. A new hire who enters CalPERS membership for the first time on or after January 1, 2013, and who has no prior membership in any California Public Retirement System.
2. A new hire who enters CalPERS membership for the first time on or after January 1, 2013, and who was a member with another California Public Retirement System prior to that date, but who is not subject to reciprocity upon joining CalPERS.
3. A member who first established CalPERS membership prior to January 1, 2013, and who is rehired by a different CalPERS agency after a break in service of greater than six (6) months.

CalPERS refers to all members that do not fit within the definition of a new member as "classic members".

Contribution rates are subject to change based on the County of Riverside annual actuarial valuation.
Note:

This summary is for general information purposes only. Additional questions regarding retirement formulas can be sent to or by calling the Benefits Information Line at (951) 955-4981,
Option 2.

If you have prior service credit with another CalPERS agency or within agencies, please contact CalPERS at (888) 225-7377 to determine which retirement tier would be applicable to you. CalPERS is governed by the Public Employees' Retirement Law. The Retirement Law is complex and subject to change. If there's any conflict between this summary and the law, the law will prevail over this summary.
DEFERRED COMPENSATION: Voluntary employee contribution with a choice between two 457 deferred compensation plan options.

VACATION ACCRUAL (Bi-Weekly Accrual):

0 4 10 or more years = 160 Hours (20 Days)

Maximum Vacation leave accumulation is 480 hours.

SICK LEAVE: Four (4) hours Sick Leave accrual per pay period with unlimited accrual.

HOLIDAYS: Normally 12 paid holidays per year

BEREAVEMENT LEAVE: Allowed 5 days (3 days are County paid; 2 additional days can be taken from accrued Sick Leave balance)

BASIC LIFE INSURANCE: Equal to one times annual base salary not to exceed $50,000 of term life coverage. Premiums are paid by the County. Additional Supplemental Life plan is available for employee purchase.

DISABILITY:
Employees contribute to State Disability Insurance (SDI), which provides wage replacement benefits for those unable to work due to non-work-related illness, injury, or pregnancy. SDI also includes Paid Family Leave benefits. The wage replacement rate, as defined by current law, is between 60-70% of wages earned during the SDI eligibility period. Benefits can be coordinated with other available leave balances to provide up to 100% of regular pay.

POST RETIREMENT MEDICAL CONTRIBUTION: A monthly contribution is made by the County towards retiree health insurance offered through the County as governed by the applicable Memorandum of Understanding.

OTHER: There may be other benefit provisions as specified in the applicable Memorandum of Understanding. Please contact the recruiter listed on the job posting directly for more information.
01

Do you possess a high school diploma, G.E.D. equivalency or high school proficiency certificate?

• Yes
• No

02

Are you willing to work weekends and holidays on a rotating basis?

• Yes
• No

03

How many years of experience do you have working in a clinical, billing or medical office administration in a healthcare or Health Maintenance Organization?

• None
• 6 months or more, less than 1 year
• 1 year, but less than 2 years
• 2 years, but less than 3 years
• 3 years, but less than 4 years
• 4 years, but less than 5 years
• 5 years or more

04

Are you a current regular, temporary, or per diem employee with the Riverside University Health System (RUHS)?

• Yes
• No

05

How many years of experience do you have providing general office and administrative support?

• None
• 6 months or more, less than 1 year
• 1 year, but less than 2 years
• 2 years, but less than 3 years
• 3 years, but less than 4 years
• 4 years, but less than 5 years
• 5 years or more

06

How many years of experience do you have managing inventory control and purchasing?

• None
• 6 months or more, less than 1 year
• 1 year, but less than 2 years
• 2 years, but less than 3 years
• 3 years, but less than 4 years
• 4 years, but less than 5 years
• 5 years or more

07

How many years of experience do you have handling scheduling and timekeeping?

• None
• 6 months or more, less than 1 year
• 1 year, but less than 2 years
• 2 years, but less than 3 years
• 3 years, but less than 4 years
• 4 years, but less than 5 years
• 5 years or more

08

How many years of experience do you have using Microsoft 365 applications (Word, Excel, Teams, Outlook)?

• None
• 6 months or more, less than 1 year
• 1 year, but less than 2 years
• 2 years, but less than 3 years
• 3 years, but less than 4 years
• 4 years, but less than 5 years
• 5 years or more

09

How many years of clerical experience do you have?

• None
• 6 months or more, less than 1 year
• 1 year, but less than 2 years
• 2 years, but less than 3 years
• 3 years, but less than 4 years
• 4 years, but less than 5 years
• 5 years or more

Required Question