Your Role on the TeamPosition 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 SuccessfulRequired 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 RewardsWe 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.
Consideration for Work Authorization SponsorshipMust be able to provide proof of work authorization
