Utilization Management Manager — Nursing Leader, Hybrid

UC San Diego; San Diego (CA); Hybrid; USD 132,600 - 259,800; Full time

Job summary

UC San Diego is seeking a Manager of Utilization Management to oversee the team handling Managed Care Utilization Management duties. This role entails supervising Nurse Case Manager and Referral Coordinator staff, guaranteeing compliance with regulations, and ensuring efficient day-to-day operations.

The ideal candidate will possess a Bachelor's degree in nursing, be a Registered Nurse in California, and have extensive experience in managing health plans. A hybrid work model is offered with varying onsite days required.

Qualifications

• Five or more years of relevant experience with a focus on IPA/MSO or Health Plan/HMO.
• Strong hands‑on experience with prior authorization review processes.
• Ability to communicate effectively with diverse groups.

Responsibilities

• Oversee department operations and staff scheduling.
• Coordinate case management teams for review and optimization.
• Analyze UM processes and report on outcomes.
• Collaborate on operational improvements for UM systems.

Skills

Supervision

Communication

Prior Authorization

Regulatory Compliance

Team Coordination

Data Analysis

Technology Skills

Education

Bachelor's degree in nursing

Registered Nurse in California

Tools

Epic

MCG

Job description

UC San Diego is seeking a Manager of Utilization Management to oversee the team handling Managed Care Utilization Management duties. This role entails supervising Nurse Case Manager and Referral Coordinator staff, guaranteeing compliance with regulations, and ensuring efficient day-to-day operations.

The ideal candidate will possess a Bachelor's degree in nursing, be a Registered Nurse in California, and have extensive experience in managing health plans. A hybrid work model is offered with varying onsite days required.