Surgical Utilization & Admission Lead

UCI Health; Orange (CA); Sur place; USD 120 000 - 170 000; Plein temps

Résumé du poste

UCI Health is seeking a Presurgical Utilization Manager to oversee preoperative utilization review and ensure accurate patient status before surgery. You will collaborate with surgeons, anesthesia leadership, scheduling, and case management to optimize clinical appropriateness and regulatory compliance.

The role requires a Bachelor’s in Nursing, an active RN license, and at least 5 years in utilization or perioperative services, with strong analytical and communication skills to minimize denials

Qualifications

• Minimum 5 years in utilization management, case management, or perioperative services.
• Knowledge of CMS rules, InterQual and/or Milliman criteria.
• Excellent written and verbal communication skills in English.
• Deep knowledge of inpatient vs. outpatient regulatory requirements.
• Bachelor’s degree in Nursing.
• Analytical mindset with focus on denial prevention and a high attention to detail and compliance.

Responsabilités

• Oversee preoperative utilization review processes to ensure accurate patient status designation (Inpatient vs Outpatient/Observation) prior to surgery.
• Partner with surgeons, anesthesia leadership, scheduling teams, and case management to optimize clinical appropriateness and regulatory compliance.
• Minimize denials, ensure compliance, and support appropriate resource utilization.

Connaissances

Physician engagement

Cross-functional collaboration

Surgical workflows

Utilization management

Case management

Perioperative services

Regulatory compliance

MS Windows

Excel

Access

Word

PowerPoint

Formation

Bachelor’s degree in Nursing

RN License

Outils

MS Windows

Excel

Access

Word

PowerPoint

Description du poste

UCI Health is seeking a Presurgical Utilization Manager to oversee preoperative utilization review and ensure accurate patient status before surgery. You will collaborate with surgeons, anesthesia leadership, scheduling, and case management to optimize clinical appropriateness and regulatory compliance.

The role requires a Bachelor’s in Nursing, an active RN license, and at least 5 years in utilization or perioperative services, with strong analytical and communication skills to minimize denials