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Manager Utilization Management Jobs in California

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Manager Utilization Management information

See California salary details

$38.5K

$89.8K

$165.3K

How much do manager utilization management jobs pay per year?

As of Jul 15, 2026, the average yearly pay for manager utilization management in California is $89,819.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,700.00 and $108,100.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Manager Utilization Management, and why are they important?

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

What is the difference between Manager Utilization Management vs Utilization Review Nurse?

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

What are some common challenges faced by a Manager in Utilization Management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

What does a Manager of Utilization Management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.
What are the most commonly searched types of Utilization Management jobs in California? The most popular types of Utilization Management jobs in California are:
What are popular job titles related to Manager Utilization Management jobs in California? For Manager Utilization Management jobs in California, the most frequently searched job titles are:
What job categories do people searching Manager Utilization Management jobs in California look for? The top searched job categories for Manager Utilization Management jobs in California are:
What cities in California are hiring for Manager Utilization Management jobs? Cities in California with the most Manager Utilization Management job openings:
Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in California as of July 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 2% Temporary, and 2% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $89,819 per year, or $43.2 per hour.
Manager, Utilization Management Nurse Management

Manager, Utilization Management Nurse Management

Blue Shield of California

El Dorado Hills, CA • On-site

$111K - $167K/yr

Full-time

Re-posted 23 days ago

Blue Shield Of California rating

8.4

Company rating: 8.4 out of 10

Based on 49 frontline employees who took The Breakroom Quiz

101st of 281 rated insurance

Job description


Your Role
The Utilization Management team reviews inpatient stays and prior authorization for our members and correctly applies the guidelines for nationally recognized levels of care for both our Medi-Cal and Medicare populations. The Utilization Management Manager will report to the Director of Utilization Management. In this role you will lead and support a team of clinicians to ensure safe, timely, and appropriate care for members. You will apply advanced clinical knowledge and proven management skills to organize work, coach staff, and manage risk. Your leadership helps drive consistent, high-quality utilization management outcomes.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Responsibilities
Your Work
In this role, you will:
  • Establish operational objectives for department or functional area and participate with other managers to establish group objectives
  • Be responsible for team, department, or functional area results in terms of planning, cost; in collaboration with department Director
  • Participate in the development and implementation of the annual budget under the direction of Sr Manager / Director
  • Ensure workflow procedures and guidelines are clearly documented and communicated
  • Interpret or initiate changes in guidelines/policies/procedures
  • Establish and manage operational and regulatory reports
  • Ensure regulatory and accreditation standards are met for Medicare, and Medi-Cal lines of business
  • Collaborate across functional departments to improve member outcomes
  • Participate in regulatory and internal audits as applicable
  • Support and facilitate staff meetings, clinical rounds, and weekly huddles

Qualifications
Your Knowledge and Experience
  • Requires maintaining an active, unrestricted RN license in assigned states or the ability to obtain required state (in addition to primary state license) RN license within 90 days of hire
  • Requires 7 years of prior relevant experience including 3 years of management experience gained as a team leader, supervisor or project/program manager
  • Requires knowledge of regulatory requirements for government lines of business (Medi-Cal and Medicare)
  • Bachelor of Science in Nursing or advanced degree preferred
  • Demonstrated experience with basic management approaches such as work scheduling, prioritizing, coaching, process execution, work organization, inventory management, risk management and delegation
  • Strong emotional intelligence skills
  • Strong communication and computer navigation skills
  • Strong teamwork and collaboration skills
  • Strong critical thinking skills
  • Independent motivation and strong work ethic

Hybrid Virtual Work
This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.
About the Team
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!
Our Values:
  • Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
  • Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
  • Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model
We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
  • For most teams, this means coming into the office two days per week.
  • Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
  • For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Please click here for further physical requirement detail.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

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