Presurgical Utilization Manager - Surgery Admin - FT, Days (Limited Appointment)

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

Who We Are

UCI Health is one of California's largest academic health systems and the clinical enterprise of the University of California, Irvine. Established on July 1, 1976, UCI Health has grown into a 1,461-bed health system that includes UCI Health - Orange, UCI Health - Irvine, four Community Network hospitals and a growing network of ambulatory care centers across Orange and Los Angeles counties. As Orange County’s only academic health systems, UCI Health is home to the only National Cancer Institute-designated comprehensive cancer center based in the county, the region’s only American College of Surgeons-verified Level I adult and Level II pediatric trauma center, American College of Emergency Physicians Gold Level 1 Geriatric Emergency Department and a nationally recognized regional burn center verified by the American Burn Association. Powered by UC Irvine, UCI Health serves 5.6 million people across Orange County, western Riverside County and southeast Los Angeles County through excellence in patient care, research and medical education.

Your Role on the Team

Position Summary:

The Presurgical Utilization Manager is responsible for overseeing preoperative utilization review processes to ensure accurate patient status designation (Inpatient vs. Outpatient/Observation) prior to surgery. This role partners closely with surgeons, anesthesia leadership, scheduling teams, and case management to optimize clinical appropriateness, regulatory compliance, and financial stewardship. The role ensures that all surgical patients are assigned the correct admission status based on clinical criteria, payer requirements, and organizational protocols—minimizing denials, ensuring compliance, and supporting appropriate resource utilization.

What It Takes to be Successful

Required Qualifications:

• Strong physician engagement and influence skills as well as the ability to work cross-functionally (surgery, anesthesia, revenue cycle, case management)
• Strong experience with surgical workflows and pre-admission processes
• Must possess the skill, knowledge, and ability essential to the successful performance of assigned duties
• Must demonstrate customer service skills appropriate to the job
• Minimum 5 years in utilization management, case management, or perioperative services.
• Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, PowerPoint, internet, e‑mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop-down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job
• Familiarity with CMS rules, InterQual and/or Milliman criteria
• Excellent written and verbal communication skills in English
• Deep knowledge of inpatient vs. outpatient regulatory requirements
• Current RN License
• Computer literacy and proficiency
• Bachelor’s degree in Nursing
• Analytical mindset with focus on denial prevention and a high attention to detail and compliance.
• Ability to manage multiple concurrent projects and maintain a work pace appropriate to the workload

Preferred Qualifications:

• Master’s Degree (MSN, MHA)
• Knowledge of University policies and procedures.
• Certification in Case Management (CCM) or Utilization Review (CPUR) preferred

Total Rewards

We offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks. Please utilize the links listed here to learn more about our compensation practices and benefits.

Conditions of Employment

The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment:

• Background Check and Live Scan
• Employment Misconduct*
• Legal Right to Work in the United States
• Vaccination Policies
• Smoking and Tobacco Policy
• Drug Free Environment

The following additional conditions may apply, some of which are dependent upon business unit or job specific requirements.

• California Child Abuse and Neglect Reporting Act
• E-Verify
• Pre-Placement Health Evaluation

Details of each policy may be reviewed by visiting the following page: https://hr.uci.edu/new-hire/conditions-of-employment.php

Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.

Closing Statement

The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the UC Anti-Discrimination Policy.

We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable, and welcoming.

UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact UCI's Employee Experience Center (EEC) at [e-mail] or at [phone], Monday - Friday from 8:30 a.m. - 5:00 p.m.

Consideration for Work Authorization Sponsorship

Must be able to provide proof of work authorization