(RN) Prior Authorization UM Case Manager - Hybrid

(RN) Prior Authorization UM Case Manager - Hybrid - 139431

Job Details

Payroll Title: 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 Date Posted 04/23/2026

Greenwich Drive 6256 Greenwich Drive, San Diego, CA 92122, United States

#139431 (RN) Prior Authorization UM Case Manager - Hybrid

Filing Deadline: Thu 5/7/2026

UC San Diego values and welcomes people from all backgrounds. If you are interested in being part of our team, possess the needed licensure and certifications, and feel that you have most of the qualifications and/or transferable skills for a job opening, we strongly encourage you to apply.

UCSD Layoff from Career Appointment: Apply by 04/28/2026 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.

This position may work a hybrid schedule, which includes a combination of working both onsite at Greenwich Drive and remote. Current department requirement is on-site one day per week.

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 recent 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: $153,489 - $202,432 (will be prorated if the appointment percentage is less than 100%)

Hourly Equivalent: $73.51 - $96.95

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).

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. 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.

UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and dozens of outpatient clinics. We invite you to join our team!

Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.

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.

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:

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.

Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer.

a. "Misconduct" means any violation of the policies governing employee conduct at the applicant's previous place of employment, including, but not limited to, violations of policies prohibiting sexual harassment, sexual assault, or other forms of harassment, or discrimination, as defined by the employer. For reference, below are UC's policies addressing some forms of misconduct:

• UC Sexual Violence and Sexual Harassment Policy
• UC Anti-Discrimination Policy
• Abusive Conduct in the Workplace