Utilization Management Manager (RN) – Inpatient & IPA/MA

University of California - San Diego Medical Centers; San Diego (CA); Hybrid; USD 137,000 - 268,000; Full time

Benefits offered by this job

Hybrid Schedule

Job summary

University of California - San Diego Medical Centers seeks a Manager of Utilization Management to supervise Nurse Case Manager and Referral Coordinator teams handling inpatient UM for commercial and Medicare Advantage plans.

This role oversees UM operations, ensures regulatory compliance, and guides process improvements across the referral determination and authorization workflows. Hybrid schedule with in-office presence 1–2 days weekly may apply.

Qualifications

• Bachelor's degree in nursing.
• Registered Nurse in the state of California.
• 5+ years of relevant experience including IPA/MSO or Health Plan/HMO experience.
• Experience with Commercial and Medicare lines of business.
• Strong experience with prior authorization review process.
• Knowledge of DOFRs, MCG, Epic, Prior Authorizations, HMO delegation, compliance, risk, appeals, and grievances.
• Proven ability to supervise a team and manage complex workflows.
• Excellent verbal and written communication across levels.

Responsibilities

• Oversee day-to-day department operations and staff coverage for UM.
• Coordinate case management with clinical and nonclinical staff on routine and complex cases.
• Collect, analyze, and report data on UM processes and results.
• Collaborate with management on new processes and programs to improve UM systems.
• Coach and evaluate staff; participate in hiring and performance decisions.
• Facilitate staff training and development and orientation of new personnel.

Skills

Nursing supervision

Team leadership

Communication skills

Prior authorization review

Regulatory compliance

Education

Bachelor's degree in nursing

RN license (California)

Tools

Epic

EPC

MCG

Job description

University of California - San Diego Medical Centers seeks a Manager of Utilization Management to supervise Nurse Case Manager and Referral Coordinator teams handling inpatient UM for commercial and Medicare Advantage plans.

This role oversees UM operations, ensures regulatory compliance, and guides process improvements across the referral determination and authorization workflows. Hybrid schedule with in-office presence 1–2 days weekly may apply.