By MedScholaria Consulting | April 2025
Temecula, California is facing a critical but under-discussed challenge: a shortage of experienced nurses in non-bedside roles, specifically in Utilization Management (UM) and Case Management (CM). These vital roles oversee care coordination, prior authorizations, and discharge planning—functions that are essential for smooth patient transitions and cost-effective healthcare.
While local and national focus has remained on bedside shortages, administrative leadership roles have quietly suffered. This has a direct impact on the quality, safety, and efficiency of care across the region.
🚨 What’s Happening in Riverside County?
In 2023, nurses at Riverside Community Hospital held a 10-day strike, citing unsafe staffing and systemic coordination failures (SEIU Local 121RN, 2023). At the same time, the Riverside/Fontana region fell below the recommended nurse-to-population ratio, a sign of growing workforce strain (California Health and Human Services Open Data Portal, 2020).
Nurses are burning out and many are looking to transition away from bedside roles. But even when they’re ready for a new direction, they’re faced with a frustrating reality: there is no structured local pathway to prepare them for UM or CM roles. Courses are limited, training support is rare, and leadership onboarding is inconsistent at best.
📉 When the System Breaks Down
The consequences of underfilled UM and CM positions are not theoretical. They’re already showing up in delayed discharges, misallocated resources, and costly payer errors.
Consider one Medicare patient case: an automatic approval for skilled nursing care wasn’t reviewed until two weeks later by a UM nurse. It turned out the patient didn’t need that level of care—but a Notice of Medicare Non-Coverage (NOMNC) was never issued on time, violating CMS rules and wasting three weeks of skilled care coverage (Centers for Medicare & Medicaid Services, n.d.).
This case illustrates how gaps in staffing and training ripple throughout the care system, resulting in inefficiencies, delays, and unnecessary healthcare spending.
🎓 The Local Solution: MedScholaria Consulting
Here at MedScholaria Consulting, we believe Temecula holds the key to solving this challenge. As a local, BRN-approved continuing education (CE) provider, we deliver specialized UM and CM education designed to help nurses successfully transition into leadership roles—without increasing costs for employers or nurses.
While some national platforms like Nurse.com (n.d.) offer online UM courses, they’re limited and generic. UC Riverside Extension lists one relevant course, but it’s often unavailable or waitlisted (University of California, Riverside Extension, n.d.). In contrast, MedScholaria provides on-demand, scenario-based, and regulation-aligned CE right here in Temecula.
Our model supports workforce initiatives like Riverside County’s WIOA Policy 19-01, which already funds career training for emerging healthcare workers—yet lacks offerings for experienced nurses moving into new roles (Riverside County Economic Development Agency, 2019).
📈 A Scalable Model with National Potential
As of April 2025, there are 34 open Utilization Management Nurse positions posted within 25 miles of Temecula (Indeed, n.d.). These vacancies represent real opportunity—and real consequences if left unfilled.
This leadership shortage also contributes to why the U.S. continues to have the highest healthcare costs in the world. When there aren’t enough UM nurses to assess medical necessity, unnecessary care slips through, driving up system-wide spending.
Upskilling the existing workforce through targeted CE is the most cost-effective and sustainable solution. Temecula has the infrastructure, the workforce, and now, the platform—MedScholaria—to lead this transformation locally and scale it nationally.
Ready to Transition from Bedside to Leadership?
Explore our BRN-approved CE programs in Utilization Management and Case Management today.
👉 View Our Courses
Let’s build the future of nursing leadership—starting in our own community.
📚 References
California Health and Human Services Open Data Portal. (2020). Registered nurse shortage areas in California [Data set]. https://data.chhs.ca.gov/dataset/registered-nurse-shortage-areas-in-california/resource/73f4c56c-ba4f-4cb7-bb69-b0727a0f5a50
Centers for Medicare & Medicaid Services. (n.d.). Instructions for the Notice of Medicare Non-Coverage (NOMNC) [PDF]. https://www.cms.gov/medicare/medicare-general-information/bni/downloads/instructions-for-notice-of-medicare-non-coverage-nomnc.pdf
Indeed. (n.d.). Utilization management nurse jobs in Temecula, CA [Job listings]. https://www.indeed.com/jobs?q=Utilization+Management+Nurse&l=Temecula%2C+CA&radius=25&vjk=88d79fdd1dc8d80d
MedScholaria Consulting. (n.d.). Continuing education courses [Web page]. https://medscholaria.com/shop/
Nurse.com. (n.d.). Search results for “utilization review” [Web page]. https://www.nurse.com/catalogsearch/result?q=utilization%20review&p=1
Riverside County Economic Development Agency – Workforce Division. (2019, October 25). Policy 19-01: WIOA Youth Program Policies & Procedures Manual. https://rivcoworkforce.org/sites/g/files/aldnop141/files/users/user116/Policy%2019-01%20Youth%20Manual.pdf
SEIU Local 121RN. (2023, August 29). Riverside Community Hospital nurses stage picket over unsafe staffing, working conditions. https://seiu121rn.org/2023/08/29/riverside-community-hospital-nurses-stage-picket-over-unsafe-staffing-working-conditions/
University of California, Riverside Extension. (n.d.). Utilization management in the U.S. health care system [Course description]. https://portal.ucx.ucr.edu/search/publicCourseSearchDetails.do?method=load&courseId=722857&selectedProgramAreaId=41480&selectedProgramStreamId=41482