UC San Diego Health
(RN) Prior Authorization UM Case Manager - Hybrid - 137689
UC San Diego Health, San Diego, California, United States, 92189
CASE MGR EX CEH
Department:
PHSO - CLINICAL OPERATIONS
Hiring Pay Scale:
$144,711 - $190,885 / Year
Worksite:
Greenwich Drive
Appointment Type:
Career
Appointment Percent:
100%
Union:
HX Contract
Total Openings:
1
Work Schedule:
Days, 8 Hour Shifts, Monday - Friday
Hybrid Work:
On-site at Greenwich Drive one day per week; remote work possible.
Job Description UC San Diego Health is a Magnet designated organization, which is a prestigious recognition that applies to only 10% of all U.S. hospitals. Magnet is the “gold standard” for nursing excellence and is based on strengths in five key areas, which include transformational leadership, structural empowerment, exemplary professional practice, new knowledge, innovation and improvements and empirical outcomes. UC San Diego Health has held its Magnet status since 2011.
The Prior Authorization UM Case Manager is responsible for managing the prior authorization process for various medical services, procedures, and medications. This includes ensuring that requests meet established criteria and are processed efficiently while adhering to insurance policies and medical necessity guidelines. Additionally, this role involves coordinating with healthcare providers, insurance companies, and internal teams to facilitate appropriate care and manage authorization requests effectively.
While not required, a cover letter is highly recommended when applying to this position.
Minimum Qualifications Must be a graduate from an accredited school of Nursing. RN license issued by the State of California. Minimum two (2) years of RN experience in prior authorization, utilization management, or a related healthcare field. Proven background in managing prior authorization processes. Strong preference for experience in handling outpatient services and working with insurance companies. Well-versed in medical terminology and evidence-based guidelines such as Health Plan policies and MCG (Milliman Care Guidelines) to assess the necessity and appropriateness of requested services. Proficiency in Information Systems and computer programs such as Word and Excel. Must possess excellent interpersonal and communication skills. Must be able to work within a team environment.
Preferred Qualifications BSN or Master's Degree. ACM and/or CCM certificate. Epic knowledge and experience.
Special Conditions Must have access to high-speed internet when working remotely. Must be able to work various hours and locations based on business needs. Employment is subject to a criminal background check and pre-employment physical.
Pay Transparency Act Annual Full Pay Range: $151,965 - $200,427 (will be prorated if the appointment percentage is less than 100%).
Hourly Equivalent: $72.78 - $95.99.
Application Deadline Filing Deadline: Thu 12/25/2025.
Additional Requirements If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands‑on practice and in‑person skills assessment; online-only certification is not acceptable.
If employed by the University of California, you will be required to comply with our Policy on Vaccination Programs, which may be amended or revised from time to time. Federal, state, or local public health directives may impose additional requirements.
Equal Employment Opportunity UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information. UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.
The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law.
For the University of California’s Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination
To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community.
#J-18808-Ljbffr
PHSO - CLINICAL OPERATIONS
Hiring Pay Scale:
$144,711 - $190,885 / Year
Worksite:
Greenwich Drive
Appointment Type:
Career
Appointment Percent:
100%
Union:
HX Contract
Total Openings:
1
Work Schedule:
Days, 8 Hour Shifts, Monday - Friday
Hybrid Work:
On-site at Greenwich Drive one day per week; remote work possible.
Job Description UC San Diego Health is a Magnet designated organization, which is a prestigious recognition that applies to only 10% of all U.S. hospitals. Magnet is the “gold standard” for nursing excellence and is based on strengths in five key areas, which include transformational leadership, structural empowerment, exemplary professional practice, new knowledge, innovation and improvements and empirical outcomes. UC San Diego Health has held its Magnet status since 2011.
The Prior Authorization UM Case Manager is responsible for managing the prior authorization process for various medical services, procedures, and medications. This includes ensuring that requests meet established criteria and are processed efficiently while adhering to insurance policies and medical necessity guidelines. Additionally, this role involves coordinating with healthcare providers, insurance companies, and internal teams to facilitate appropriate care and manage authorization requests effectively.
While not required, a cover letter is highly recommended when applying to this position.
Minimum Qualifications Must be a graduate from an accredited school of Nursing. RN license issued by the State of California. Minimum two (2) years of RN experience in prior authorization, utilization management, or a related healthcare field. Proven background in managing prior authorization processes. Strong preference for experience in handling outpatient services and working with insurance companies. Well-versed in medical terminology and evidence-based guidelines such as Health Plan policies and MCG (Milliman Care Guidelines) to assess the necessity and appropriateness of requested services. Proficiency in Information Systems and computer programs such as Word and Excel. Must possess excellent interpersonal and communication skills. Must be able to work within a team environment.
Preferred Qualifications BSN or Master's Degree. ACM and/or CCM certificate. Epic knowledge and experience.
Special Conditions Must have access to high-speed internet when working remotely. Must be able to work various hours and locations based on business needs. Employment is subject to a criminal background check and pre-employment physical.
Pay Transparency Act Annual Full Pay Range: $151,965 - $200,427 (will be prorated if the appointment percentage is less than 100%).
Hourly Equivalent: $72.78 - $95.99.
Application Deadline Filing Deadline: Thu 12/25/2025.
Additional Requirements If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands‑on practice and in‑person skills assessment; online-only certification is not acceptable.
If employed by the University of California, you will be required to comply with our Policy on Vaccination Programs, which may be amended or revised from time to time. Federal, state, or local public health directives may impose additional requirements.
Equal Employment Opportunity UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information. UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.
The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law.
For the University of California’s Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination
To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community.
#J-18808-Ljbffr