Hybrid RN: Utilization Management Lead

San Diego Supercomputer Center; San Diego (CA); Hybrid; USD 137,000 - 268,000; Full time

Job summary

UC San Diego Health seeks a Manager of Utilization Management to supervise Nurse Case Manager and Referral Coordinator staff, ensuring regulatory compliance and effective care coordination for Commercial and Medicare plans.

This 100% FTE, hybrid role requires nursing licensure in California, 5+ years in IPA/MSO or health plan environments, and expertise in prior authorizations, utilization review, discharge planning, and data reporting.

Qualifications

• Bachelor's degree in nursing.
• California RN license.
• 5+ years in IPA/MSO/Health Plan roles.
• Experience with Commercial and Medicare lines.
• Strong prioritization and supervisory skills.

Responsibilities

• Oversees day-to-day UM department operations and staff coverage.
• Leads case reviews and coordination with clinical/nonclinical teams.
• Analyzes and reports UM data and vendor relations.
• Collaborates on process improvements and program development.
• Mentors staff and participates in hiring and performance reviews.
• Ensures orientation and training for new staff.

Skills

Leadership

Communication

Prior authorization

Regulatory compliance

Education

Bachelor's degree in nursing

Tools

Epic

MCG

EPC

Job description

UC San Diego Health seeks a Manager of Utilization Management to supervise Nurse Case Manager and Referral Coordinator staff, ensuring regulatory compliance and effective care coordination for Commercial and Medicare plans.

This 100% FTE, hybrid role requires nursing licensure in California, 5+ years in IPA/MSO or health plan environments, and expertise in prior authorizations, utilization review, discharge planning, and data reporting.