Senior Utilization Management Lead

UC San Diego; San Diego (CA); Hybrid; USD 137,000 - 268,000; Full time

Benefits offered by this job

Hybrid schedule

Job summary

UC San Diego Health IPA seeks a Manager of Utilization Management to lead nurse case management and referral coordination for commercial and Medicare Advantage plans. The role focuses on inpatient UM within IPA/Health Plan settings, ensuring regulatory compliance and effective delegated UM operations.

The position requires RN licensure in California, 5+ years in UM/IPA environments, and strong leadership and data-analysis skills. Hybrid schedule with some in-office days.

Qualifications

• Bachelor's degree in nursing and California RN license.
• Minimum five years of relevant experience, including IPA/MSO or Health Plan/HMO exposure.
• Experience with Commercial and Medicare lines of business.
• Strong prior authorization review experience.
• Knowledge of DOFRs, Epic, MCG, and HMO delegation.

Responsibilities

• Oversee day-to-day UM operations and supervise staff.
• Coordinate case management with clinical and nonclinical teams.
• Analyze and report UM data and regulatory compliance.
• Collaborate on operational improvements and new processes.
• Coach staff, participate in hiring and performance decisions.
• Provide staff training and orientation on UM updates.
• Implement new methods, systems, and processes.

Skills

Leadership

Prior Authorization

Communication

Regulatory compliance

Team supervision

Education

Bachelor's degree in nursing

Tools

Epic

EPC

MCG

Job description

UC San Diego Health IPA seeks a Manager of Utilization Management to lead nurse case management and referral coordination for commercial and Medicare Advantage plans. The role focuses on inpatient UM within IPA/Health Plan settings, ensuring regulatory compliance and effective delegated UM operations.

The position requires RN licensure in California, 5+ years in UM/IPA environments, and strong leadership and data-analysis skills. Hybrid schedule with some in-office days.