Hybrid UM Manager - Inpatient Utilization & Case Mgmt

UC San Diego Health; San Diego (CA); Hybrid; USD 137,000 - 268,000; Full time

Benefits offered by this job

Hybrid work schedule

Job summary

UC San Diego Health is seeking a Manager of Utilization Management to supervise Nurse Case Manager and Referral Coordinator staff overseeing commercial and Medicare Advantage UM operations in a managed care/IPA environment. The role emphasizes inpatient UM, regulatory compliance, and delegated UM functions.

You will lead case management teams, analyze UM data, and collaborate on process improvements while coaching staff and guiding HR matters. Hybrid schedule with on-site days required.

Qualifications

• Bachelor's degree in nursing and California RN license.
• 5+ years of relevant experience including IPA/MSO or Health Plan/HMO experience.
• Experience with Commercial and Medicare lines of business.
• Strong communication and supervisory skills; able to influence at all levels.
• Experience with prior authorization review process and UR/discharge planning.

Responsibilities

• Oversees day-to-day UM department operations, schedules staff, covers workload and assists with prior authorizations and inpatient UR/discharge planning.
• Leads case management teams to review routine, expedited, and complex cases and evaluates options for quality and efficiency.
• Collects, analyzes, and reports UM data, including referrals, vendor relationships, and regulatory compliance.
• Collaborates with management on operational improvements and new processes for UM systems.
• Coaches staff and participates in hiring, salary actions, and performance reviews.
• Promotes staff development and ongoing training; ensures orientation and mentoring for new staff.
• Implements new methods, systems, and processes.
• Other duties as assigned.

Skills

Nurse leadership

Team supervision

Prior authorizations

Communication skills

Education

Bachelor's degree in nursing

Tools

Epic

EPC

MCG

Job description

UC San Diego Health is seeking a Manager of Utilization Management to supervise Nurse Case Manager and Referral Coordinator staff overseeing commercial and Medicare Advantage UM operations in a managed care/IPA environment. The role emphasizes inpatient UM, regulatory compliance, and delegated UM functions.

You will lead case management teams, analyze UM data, and collaborate on process improvements while coaching staff and guiding HR matters. Hybrid schedule with on-site days required.