Surgical Utilization Lead

University of California - Irvine Health; Orange (CA); On-site; USD 110,000 - 160,000; Full time

Job summary

University of California, Irvine Health is seeking a Presurgical Utilization Manager to oversee preoperative status designations and ensure regulatory and payer compliance. You will partner with surgeons, anesthesia leadership, and case management to optimize clinical appropriateness and resource use.

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

Qualifications

• Required RN license and Bachelor's in Nursing.
• Minimum 5 years in utilization management, case management, or perioperative services.
• Strong communication and cross-functional influence in surgery and revenue cycles.

Responsibilities

• Oversee preoperative utilization review to designate inpatient vs. outpatient status.
• Collaborate with surgeons, anesthesia leadership, scheduling, and case management.
• Minimize denials, ensure regulatory compliance, and optimize resource utilization.

Skills

Physician engagement

Cross-functional collaboration

Surgical workflows

Utilization management

Analytical mindset

Customer service

Time management

Education

Bachelor's degree in Nursing

Master's Degree (MSN, MHA)

RN Licensure

Tools

MS Windows

Excel

Access

Word

PowerPoint

CMS rules knowledge

InterQual/Milliman criteria

Job description

University of California, Irvine Health is seeking a Presurgical Utilization Manager to oversee preoperative status designations and ensure regulatory and payer compliance. You will partner with surgeons, anesthesia leadership, and case management to optimize clinical appropriateness and resource use.

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