Preop Utilization & Compliance Leader

University of California, Irvine; Orange (CA); On-site; USD 120,000 - 180,000; Full time

Benefits offered by this job

Medical insurance

Retirement plans

Paid time off

Job summary

UCI Health in Orange, CA seeks a Presurgical Utilization Manager to oversee preoperative utilization review, ensuring correct admission status and regulatory compliance.

You will partner with surgeons, anesthesia leadership, scheduling and case management to optimize clinical appropriateness and financial stewardship, minimizing denials.

Candidates should have RN licensure, a bachelor’s in nursing, five+ years in utilization or perioperative services, and strong knowledge of CMS rules.

Qualifications

• RN licensed with a BSN; five+ years in utilization management, case management, or perioperative services.
• Familiarity with CMS rules, InterQual, or Milliman criteria.
• Strong communication skills in English; ability to engage physicians and cross-functional teams.

Responsibilities

• Oversee preoperative utilization review to determine inpatient vs outpatient/observation status.
• Collaborate with surgeons, anesthesia leadership, scheduling, and case management to optimize clinical appropriateness and regulatory compliance.
• Minimize denials and support appropriate resource utilization; ensure accurate admission status based on criteria and payer requirements.

Skills

RN license

Stakeholder influence

Surgical workflows

Communication skills

Analytical mindset

Multi-project management

Regulatory knowledge

Customer service

Computer literacy

Keyboard/mouse proficiency

Education

Bachelor's degree in Nursing

Master's degree (MSN, MHA) [preferred]

Tools

MS Windows

Excel

Access

Word

PowerPoint

Internet / Email

Job description

UCI Health in Orange, CA seeks a Presurgical Utilization Manager to oversee preoperative utilization review, ensuring correct admission status and regulatory compliance.

You will partner with surgeons, anesthesia leadership, scheduling and case management to optimize clinical appropriateness and financial stewardship, minimizing denials.

Candidates should have RN licensure, a bachelor’s in nursing, five+ years in utilization or perioperative services, and strong knowledge of CMS rules.