RN Manager, Utilization Management (Hybrid)

University of California San Diego; San Diego (CA); Hybrid; USD 160,000 - 200,000; Full time

Benefits offered by this job

Hybrid Schedule

Job summary

UC San Diego Health is seeking a Manager of Utilization Management to supervise Nurse Case Manager and Referral Coordinator teams. The role focuses on inpatient UM within a managed care/IPA environment, ensuring compliance with health plan standards and regulatory requirements.

Responsibilities include coordinating teams, analyzing UM data, and leading process improvements, while guiding staff development and performance. Hybrid work schedule with some onsite days is available.

Qualifications

• Bachelor's degree in nursing is required.
• Active RN license in California.
• 5+ years of relevant experience incl. IPA/MSO or Health Plan/HMO.
• Experience with Commercial and Medicare lines of business.
• Strong prior authorizations experience and regulatory knowledge.

Responsibilities

• Oversees day-to-day UM operations and staff scheduling.
• Leads case management with clinical and nonclinical teams.
• Collects and analyzes UM data and reports.
• Collaborates on new processes to improve UM systems.
• Coaches staff and participates in HR decisions.
• Ensures orientation and mentoring for new staff.
• Implements new methods and processes.
• Performs other duties as assigned.

Skills

Prior authorization review

DOFRs knowledge

MCG knowledge

Epic knowledge

Communication skills

Team supervision

Education

Bachelor's degree in nursing

Registered Nurse in California

Tools

Epic

MCG

EPC

Job description

UC San Diego Health is seeking a Manager of Utilization Management to supervise Nurse Case Manager and Referral Coordinator teams. The role focuses on inpatient UM within a managed care/IPA environment, ensuring compliance with health plan standards and regulatory requirements.

Responsibilities include coordinating teams, analyzing UM data, and leading process improvements, while guiding staff development and performance. Hybrid work schedule with some onsite days is available.