Top 223 Utilization management Jobs in San Diego Ca

Customer Service Coordinator - SCMG Customer Service - Sharp Corporate / Remote - Day Shift - Full Time
Sharp HealthCare —San Diego, CA
- $26.13 - $36.59 an hour
- 8 hour shift
- Remote
- Research
- Mid-level
- High school diploma or GED
4d
RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)
Molina Healthcare —San Diego, CA
- $30.37 - $59.21 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Discharge planning
- Health insurance
RN Clinical Supervisor Home Health
Avantra Home Health —San Diego, CA
- $110,000 - $120,000 a year
- Full-time
- Nursing
- Skilled nursing facility
- RN License
Quick Apply
Team Lead - Mental Health (Bilingual)
CRF Behavioral Healthcare —San Diego, CA
- $101,250 - $102,262 a year
- Weekends as needed
- Spanish
- Mid-level
- Driver's License
- Paid holidays
- Disability insurance
Clinical Site Manager, Physical Therapist
Family Health Centers of San Diego —El Cajon, CA
- $90,000 - $154,885 a year
- Full-time
- Clean driving record
- BLS Certification
- Physical & Rehabilitation Medicine
- Paid holidays
- Health insurance
Quick Apply
3d
Licensed Social Worker Case Manager / PRN
Select Specialty Hospital - San Diego —San Diego, CA
- $52 an hour
- Part-time
- Mid-level
- Critical & Intensive Care
- Social Work
- Employee assistance program
- Opportunities for advancement
Quick Apply
Clinical Site Manager, Physical Therapist
Family Health Centers of San Diego —Lemon Grove, CA
- $90,000 - $154,885 a year
- Full-time
- Clean driving record
- BLS Certification
- Physical & Rehabilitation Medicine
- Paid holidays
- Health insurance
Quick Apply
3d
Nurse - RN
CRF Behavioral Healthcare —San Diego, CA
- $48.08 - $48.56 an hour
- Email
- Spanish
- Nursing
- Psychiatry
- Paid holidays
- Disability insurance
RN Case Manager
St. Paul's Senior Services —San Diego, CA
- $39.57 - $59.38 an hour
- Full-time
- CPR Certification
- Nursing
- RN License
- 403(b) matching
- Health insurance
Quick Apply
Surgery Center Administrator
NVISION Eye Centers —San Diego, CA
- $145,000 - $165,000 a year
- Full-time
- Nursing
- RN License
- 5 years
RN Clinic Manager
St. Paul's Senior Services —El Cajon, CA
- $111,700 - $167,400 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- 403(b) matching
- Health insurance
Quick Apply
Registered Nurse Case Manager
Medical Professionals —California
- $54 - $60 an hour
- Full-time
- Remote
- Background check
- RN License
- HIPAA
Quick Apply
4d
UM Licensed Vocational Nurse (REMOTE)
Medica Talent Group —California
- $33 - $46 an hour
- Temporary
- Remote
- Microsoft Excel
- Microsoft Outlook
- LVN
Quick Apply
Clinical Director
Akua Behavioral Health —San Diego, CA
- $115,000 - $125,000 a year
- Full-time
- Background check
- LMFT
- CPR Certification
- Health insurance
- Dental insurance
Quick Apply
7d
RN- Home Care
Cross Country Local —San Diego, CA
- $53 - $62 an hour
- Contract
- Nursing
- RN License
- BLS Certification
- Disability insurance
- Health insurance
Quick Apply
Registered Dietitian
Family Health Centers of San Diego —San Diego, CA
- $38.41 - $50.46 an hour
- Full-time
- Spanish
- Clean driving record
- English
- Paid holidays
- Health insurance
Quick Apply
4d
RN Case Manager - Case Management
Rady Children's Health —San Diego, CA
- $61.22 - $94.34 an hour
- Nursing
- RN License
- BLS Certification
9d
Psych Social Worker/BA - Social Services - Sharp Mesa Vista Hospital - Day Shift - Per Diem
Sharp HealthCare —San Diego, CA
- $36.00 - $50.39 an hour
- 8 hour shift
- Hospital
- BLS Certification
- Inpatient
Senior Representative, Health Plan Provider Relations (Must Reside in CA) Must have Contract exp
Molina Healthcare —El Cajon, CA
- $73,008 - $111,967 a year
- Full-time
- Medical office experience
- Contracts
- Senior level
- Health insurance
(RN) Care Manager - Care Management
UC San Diego Health —San Diego, CA
- $77.17 - $101.80 an hour
- 12 hour shift
- Nursing
- Microsoft Excel
- Microsoft Outlook

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Customer Service Coordinator - SCMG Customer Service - Sharp Corporate / Remote - Day Shift - Full Time

Sharp HealthCare -
San Diego, CA

Apply Now

Job Details

Full-time
$26.13 - $36.59 an hour
4 days ago

Qualifications

Appeals
Managed care organization experience
High school diploma or GED
Medical insurance appeals management
Insurance claims appeal handling
Stakeholder relationship building

Full Job Description

Job ID JR209876 Date posted 09/03/2026

San Diego, California

Corporate Offices
Day
Regular

Responsibilities

Hours:

Shift Start Time:

8 AM

Shift End Time:

5 PM

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

No Weekends

On-Call Required:

Hourly Pay Range (Minimum - Midpoint - Maximum):

$26.130 - $32.670 - $36.590

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do
To provide support service, education, research and informational support to both internal and external customers of Sharp Community Medical Group.

Required Qualifications

High School diploma or equivalent
3 years' experience working in the managed health care field with exposure to patient issues including claims, eligibility, appeals, and benefit level determination.
1 year experience working in a high-volume call center.

Essential Functions

Collect and compile utilization data
Develop systems to collect and compile data to assist Utilization Management department in the analysis of medical practice patterns and compliance patterns and utilization policies and procedures.
Customer service
Handle incoming calls providing prompt and courteous responses to customers. Maintain a grade of 100%.
Triage phone calls from providers, health plan members and health plans.
Use the Customer Service Computer Module to record and track all member, provider, and health plan issues.
Ensure timely follow-up on all issues
Perform Service Recovery - Apologize, Correct, Track and Take Action.
General support
Perform all other duties as assigned.
Liaison
Research and advise on the status of claims adjudication, eligibility referrals, and appeals.
Maintaining relationships
Develop and maintain good working relationships with claims department for claims adjustments and issue resolution. Work with Health Services Management department on authorization issues, and ensure prompt response to providers of appeals, quality and eligibility issues.
Patient education
Develop educational programs to educate providers on, referral process and status, benefit and claims status, in and out-of-area emergencies, physician selection and eligibility processes.
Research
Apply principles and knowledge of utilization management, community standards and health plan benefits.
Create and make determinations on authorizations for medical services in coordination with Health Services Management Dept.
Educate office staff and providers on the appeal process.

Knowledge, Skills, and Abilities

Excellent organizational and time management skills, good concentration skills and excellent verbal skills on the telephone and written communication skills.
- Data input and look up skills in IDX preferable.
Advanced ability to work independently in research and decision making
Ability to sit for extended periods of time with typing/input speeds equivalent to 35 - 40 wpm.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class

H.S. Diploma or Equivalent

Apply Now

Refine Your Search

utilization management jobs in san diego ca

Customer Service Coordinator - SCMG Customer Service - Sharp Corporate / Remote - Day Shift - Full Time

RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)

RN Clinical Supervisor Home Health

Team Lead - Mental Health (Bilingual)

Clinical Site Manager, Physical Therapist

Licensed Social Worker Case Manager / PRN

Clinical Site Manager, Physical Therapist

Nurse - RN

RN Case Manager

Surgery Center Administrator

RN Clinic Manager

Registered Nurse Case Manager

UM Licensed Vocational Nurse (REMOTE)

Clinical Director

RN- Home Care

Registered Dietitian

RN Case Manager - Case Management

Psych Social Worker/BA - Social Services - Sharp Mesa Vista Hospital - Day Shift - Per Diem

Senior Representative, Health Plan Provider Relations (Must Reside in CA) Must have Contract exp

(RN) Care Manager - Care Management

I want to receive the latest job alert for utilization management in san diego ca

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