(RN) Prior Authorization UM Case Manager - Hybrid - 139431
University of California San Diego, San Diego, CA, United States
CASE MGR EX CEH
Department: PHSO - CLINICAL OPERATIONS
Hiring Pay Scale: $153,488 - $202,431 / 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 schedule: Onsite at Greenwich Drive one day per week; the remaining days may be remote.
DESCRIPTION
UC San Diego Health is a Magnet‑designated organization, a distinction earned by 10% of U.S. hospitals. The Prior Authorization UM Case Manager will manage the prior authorization process for medical services, procedures, and medications, ensuring that requests meet established criteria and are processed efficiently while adhering to insurance policies and medical‑necessity guidelines. This role involves coordinating with healthcare providers, insurance companies, and internal teams to facilitate appropriate care and manage authorization requests.
MINIMUM QUALIFICATIONS
Graduate of an accredited school of Nursing.
Registered Nurse license issued by the State of California.
Minimum two years recent RN experience in prior authorization, utilization management, or a related healthcare field.
Proven background in managing prior authorization processes, with strong preference for experience handling outpatient services and working with insurance companies.
Well versed in medical terminology and evidence‑based guidelines such as Health Plan policies and Milliman Care Guidelines (MCG) to assess service necessity and appropriateness.
Proficiency in information systems, including Word and Excel.
Excellent interpersonal and communication skills.
Ability to work within a team environment.
PREFERRED QUALIFICATIONS
BSN or Master’s degree.
Acquired Clinical Management (ACM) and/or Case Management Certification (CCM).
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: $153,489 - $202,432 (will be prorated if the appointment percentage is less than 100%).
Hourly Equivalent: $73.51 - $96.95.
Compensation will be determined based on experience, skills, knowledge, abilities, education, licensure, certifications, and other organizational needs.
EQUAL OPPORTUNITY EMPLOYER
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.
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Department: PHSO - CLINICAL OPERATIONS
Hiring Pay Scale: $153,488 - $202,431 / 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 schedule: Onsite at Greenwich Drive one day per week; the remaining days may be remote.
DESCRIPTION
UC San Diego Health is a Magnet‑designated organization, a distinction earned by 10% of U.S. hospitals. The Prior Authorization UM Case Manager will manage the prior authorization process for medical services, procedures, and medications, ensuring that requests meet established criteria and are processed efficiently while adhering to insurance policies and medical‑necessity guidelines. This role involves coordinating with healthcare providers, insurance companies, and internal teams to facilitate appropriate care and manage authorization requests.
MINIMUM QUALIFICATIONS
Graduate of an accredited school of Nursing.
Registered Nurse license issued by the State of California.
Minimum two years recent RN experience in prior authorization, utilization management, or a related healthcare field.
Proven background in managing prior authorization processes, with strong preference for experience handling outpatient services and working with insurance companies.
Well versed in medical terminology and evidence‑based guidelines such as Health Plan policies and Milliman Care Guidelines (MCG) to assess service necessity and appropriateness.
Proficiency in information systems, including Word and Excel.
Excellent interpersonal and communication skills.
Ability to work within a team environment.
PREFERRED QUALIFICATIONS
BSN or Master’s degree.
Acquired Clinical Management (ACM) and/or Case Management Certification (CCM).
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: $153,489 - $202,432 (will be prorated if the appointment percentage is less than 100%).
Hourly Equivalent: $73.51 - $96.95.
Compensation will be determined based on experience, skills, knowledge, abilities, education, licensure, certifications, and other organizational needs.
EQUAL OPPORTUNITY EMPLOYER
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.
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