UM/QI/Capitation Nurse (RN) - Utilization Management

This is a fulltime authorization nurse, experience with health plan authorization process is strongly preferred.May be considered a hybrid positionJOB SUMMARY:Under the supervision of the Supervisor, UM Clinical, the Utilization/Case Manager Nurse coordinates the delivery of care through assessment, planning, facilitation, & patient advocacy to ensure cost-effective, quality outcomes of care. The Utilization/Case Manager Nurse works with all members of the health care team to ensure optimal outcomes are reached while appropriate utilization occursMINIMUM QUALIFICATIONS:Associate's Degree3 years of experienceCalifornia RN LicenseKnowledge of common medical insurance operationsManaged Care experience (will consider Hospital Case Management Experience)Strong mathematical and reasoning skillsPREFERRED QUALIFICATIONS:Bachelor's DegreePediatric Nursing ExperienceThe current salary range for this position is $45.75 to $62.90Rady Children's Hospital is committed to compensation that is externally competitive and internally equitable. We demonstrate this commitment by conducting regular market reviews to remain competitive with organizations of similar size in the nonprofit, healthcare sector. The range listed above does not represent the full salary range for the position but is the expected hiring range for qualified candidates. Compensation decisions consider a variety of factors including experience, education, licensure, unique skillsets, organizational need, and internal equity. This posting will remain open from the "date posted" until the hiring manager has determined there is a sufficient applicant pool or until the position is filled.EOE including disability/vet

Created: 2026-03-04