(RN) Prior Authorization UM Case Manager - Hybrid
The University of California, San Diego
About this position
Position 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.
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.
Job Location
Greenwich Drive