Utilization Review Manager Jobs in Poway, CA (NOW HIRING)

UCSD Layoff from Career Appointment: Apply by 07/31/2026 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor.

Reassignment Applicants: Eligible Reassignment clients should contact their Disability Counselor for assistance.

UC San Diego Health is proud to be a four-time Magnet-designated organization and has now earned Magnet with Distinction from the American Nurses Credentialing Center (ANCC). Magnet is the gold standard for nursing excellence, achieved by only about 10% of hospitals worldwide. Magnet with Distinction is awarded to the highest-performing Magnet organizations, with only a select few earning this prestigious honor. This recognition reflects our commitment to transformational leadership, professional nursing excellence, innovation, exceptional patient outcomes, and an empowering practice environment where nurses thrive.

Our Care Managers are essential members of our healthcare team who positively affect our patient and organization outcomes. UCSD is a tertiary-level acute hospital, so the Care Managers coordinate care for medically complex patients, allowing them to use their strong critical thinking skills and creative discharge planning. The Care Management Department is comprised of highly skilled Care Managers and Social Workers to provide excellent patient care for our diverse and complex patient population. This dynamic department continues to expand and grow every year, adding more valuable team members.

Under general supervision, the RN Care Manager is responsible for facilitating the patient's hospitalization from pre-admission through discharge. The Care Manager coordinates with physicians, nurses, social workers, and other healthcare providers to expedite medically appropriate, cost-effective care. The Care Manager applies clinical expertise and medical appropriateness criteria to resource utilization and discharge planning. The Care Manager will communicate with the administration and the healthcare team as needed to facilitate patient care.

While not required, a cover letter is highly recommended when applying to this position.

• Must be a graduate from an accredited school of Registered Nursing.

• Registered Nurse (RN) license issued by the State of California.

• BART or BLS at time of hire with commitment to get BART within six (6) months of hire date.

• **Minimum of 3 years prior inpatient RN care manager experience in an acute care hospital, or a minimum of 3 years of inpatient RN experience in the acute care hospital setting with demonstrated expertise in discharge planning, interprofessional communication, knowledge of post-acute care resources, excellent organizational and time management skills, and ability to prioritize and manage multiple tasks simultaneously, or a minimum of 3 years combined inpatient RN care manager and inpatient RN experience in the acute care hospital setting, within the last 7 years.

• Demonstrated utilization review/discharge planning experience.

• Knowledge of the payer industry, resource management, reimbursement, and evidence-based clinical practice is essential.

• Proficiency in Information Systems, databases, and computer programs, including MS Office: Word, Excel, Outlook, PowerPoint, etc.

• Proven fast and accurate typing and data entry skills.

• Strongly skilled in conflict management and resolution.

• Must possess strong interpersonal skills, leadership, negotiation skills, and knowledge of hospital operations.

• BSN/MSN. (Department will consider ADN candidates with a minimum of 3 years acute care inpatient RN case management experience.)

• ACM and/or CCM certificate.

• Med/Surg, progressive care, or ED clinical RN experience.

• Strong utilization review and InterQual experience.

• UCSD RN experience or RN experience in another academic medical center.

• Previous supervisory/management experience.

• RN experience in a post-acute care facility or home health agency.

• Familiar with Epic, ECIN (Allscripts), and/or Utilization Review / InterQual.

• Knowledge of local payers and coverage, reimbursement, and evidence-based clinical nursing practice.

• Must be able to work various hours and locations based on business needs.
• Employment is subject to a criminal background check and a pre-employment physical.

Pay Transparency Act

Annual Full Pay Range: $161,140 - $212,555 (will be prorated if the appointment percentage is less than 100%)

Hourly Equivalent: $77.17 - $101.80

Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable).