Your Role on the Team

Position Summary:

The Presurgical Utilization Manager is responsible for overseeing preoperative utilization review processes to ensure accurate patient status designation (Inpatient vs. Outpatient/Observation) prior to surgery. This role partners closely with surgeons, anesthesia leadership, scheduling teams, and case management to optimize clinical appropriateness, regulatory compliance, and financial stewardship. The role ensures that all surgical patients are assigned the correct admission status based on clinical criteria, payer requirements, and organizational protocols-minimizing denials, ensuring compliance, and supporting appropriate resource utilization.

What It Takes to be Successful

Required Qualifications:

• Strong physician engagement and influence skills as well as the ability to work cross-functionally (surgery, anesthesia, revenue cycle, case management)
• Strong experience with surgical workflows and pre-admission processes
• Must possess the skill, knowledge, and ability essential to the successful performance of assigned duties
• Must demonstrate customer service skills appropriate to the job
• Minimum 5 years in utilization management, case management, or perioperative services.
• Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, PowerPoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop-down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the 1st two weeks of employment to perform the essential functions of the job
• Familiarity with CMS rules, InterQual and/or Milliman criteria
• Excellent written and verbal communication skills in English
• Deep knowledge of inpatient vs. outpatient regulatory requirements
• Current RN License
• Computer literacy and proficiency
• Bachelor's degree in Nursing
• Analytical mindset with focus on denial prevention and a high attention to detail and compliance.
• Ability to manage multiple concurrent projects and maintain a work pace appropriate to the workload

Preferred Qualifications:

• Master's Degree (MSN, MHA)
• Knowledge of University policies and procedures.
• Certification in Case Management (CCM) or Utilization Review (CPUR) preferred

Total Rewards

We offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks. Please utilize the links listed here to learn more about our compensation practices and benefits.

Conditions of Employment:

The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment:

• Background Check and Live Scan
• Employment Misconduct*
• Legal Right to Work in the United States
• Vaccination Policies
• Smoking and Tobacco Policy
• Drug Free Environment

*Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional 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; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.

The following additional conditions may apply, some of which are dependent upon business unit or job specific requirements.

• California Child Abuse and Neglect Reporting Act
• E-Verify
• Pre-Placement Health Evaluation

Details of each policy may be reviewed by visiting the following page: https://hr.uci.edu/new-hire/conditions-of-employment.php

Consideration for Work Authorization Sponsorship

Must be able to provide proof of work authorization