Preoperative Utilization Lead

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

Job summary

UCI Health is seeking a Presurgical Utilization Manager to lead preoperative utilization reviews and assign correct admission status. You will work closely with surgeons, anesthesia leadership, scheduling, and case management to ensure clinical appropriateness, payer compliance, and efficient resource use.

The role requires strong analytical skills, CMS/interQual knowledge, and a track record of reducing denials while maintaining high-quality patient care in a fast-paced perioperative

Qualifications

• RN license and BSN required.
• Minimum 5 years in utilization management, case management, or perioperative services.
• Knowledge of CMS rules, InterQual and/or Milliman criteria.
• Proficient in MS Windows, Excel, Access, Word, PowerPoint; strong computer skills.
• Excellent written and verbal English communication.

Responsibilities

• Oversee preoperative utilization review to determine inpatient vs outpatient status.
• Partner with surgeons, anesthesia leadership, scheduling, and case management.
• Ensure compliance with payer requirements and organizational protocols.
• Minimize denials and optimize resource utilization.

Skills

Physician engagement

Cross-functional collaboration

Surgical workflows

Customer service

Analytical mindset

Project management

English communication

Regulatory knowledge

Education

Bachelor’s degree in Nursing

RN License

Master’s Degree (MSN, MHA)

Tools

MS Windows

Excel

Access

Word

PowerPoint

Email/Internet

Job description

UCI Health is seeking a Presurgical Utilization Manager to lead preoperative utilization reviews and assign correct admission status. You will work closely with surgeons, anesthesia leadership, scheduling, and case management to ensure clinical appropriateness, payer compliance, and efficient resource use.

The role requires strong analytical skills, CMS/interQual knowledge, and a track record of reducing denials while maintaining high-quality patient care in a fast-paced perioperative