RN Manager, Utilization Management (Hybrid)

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 in California to supervise Nurse Case Manager and Referral Coordinator staff for commercial and senior attributed IPA members.

The role oversees day-to-day UM operations, leads case reviews, analyzes data, and partners with leadership to improve UM systems. Hybrid schedule with in-office days is required, and professional development is encouraged.

Qualifications

• Bachelor's degree in nursing and CA RN license.
• Five+ years of relevant experience, including IPA/MSO or Health Plan/HMO.
• Experience with Commercial and Medicare lines of business.
• Strong prior authorization review experience and process knowledge.
• Knowledge of DOFRs, MCG, Epic, Prior Authorizations, and HMO delegation.
• Ability to supervise a team and manage multiple priorities with excellent communication.

Responsibilities

• Oversee day-to-day UM department operations and staffing.
• Lead case management teams to review routine, expedited, and complex cases.
• Collect, analyze, and report data on UM processes and outcomes.
• Collaborate with management to develop new UM processes and programs.
• Coach staff and participate in hiring, performance, and HR decisions.
• Ensure orientation, training, and ongoing staff development.
• Provide guidance on UM updates to processes and clinical guidelines.

Skills

Nurse leadership

Team supervision

Effective communication

Analytical skills

Education

Bachelor's degree in nursing

Tools

Epic

MCG

Job description

UC San Diego Health is seeking a Manager of Utilization Management in California to supervise Nurse Case Manager and Referral Coordinator staff for commercial and senior attributed IPA members.

The role oversees day-to-day UM operations, leads case reviews, analyzes data, and partners with leadership to improve UM systems. Hybrid schedule with in-office days is required, and professional development is encouraged.