Senior Manager of Utilization Management & Case Management
Prime Healthcare Management Inc
Ontario, CAFull-time$111–173K/yrPosted 1 day agoStill listed today
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At a glance
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Job overview
The Senior Manager of Utilization Management & Case Management provides strategic leadership and operational oversight for outpatient prior authorization, inpatient concurrent review, case management, and medical appeals. The role leads clinical and non-clinical professionals and ensures care aligns with regulatory standards, including NCQA, CMS, and state mandates, as well as health plan policies.
Skills & qualifications
Skills
Qualifications
Benefits
Full job description
Overview
Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!
Responsibilities
The Senior Manager of Utilization Management & Case Management provides strategic leadership and operational oversight for core clinical operations, including outpatient prior authorization, inpatient concurrent review, case management, and medical appeals. This role ensures the delivery of high-quality, cost-effective care that aligns with regulatory standards (NCQA, CMS, state mandates) and health plan policies while leading a high-performing team of clinical and non-clinical professionals
Qualifications
Required qualifications:
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Active, unrestricted Licensed Vocational Nurse (LVN) license in the state of operation (highly preferred). Lean or advanced clinical degrees (e.g., RN, BSN, MSN, LCSW) are a plus.
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Certified Case Manager (CCM) or Certified Professional in Utilization Review (CPUR) designation is highly desirable or relevant experience managing teams.
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5+ years of clinical nursing or healthcare experience.
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3-5 years of progressive leadership/management experience within a managed care organization (MCO), health plan, or insurance setting.
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Deep knowledge of Medicare, Medicaid, Commercial, and Marketplace insurance regulations.
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Proficiency with health plan software (e.g., MCG, InterQual, CMS).
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Strong data analytics skills to translate operational metrics into actionable clinical strategies.
Pay Transparency
Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $110,968.00 to $173,035.20 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.
Employment Status Full Time Shift Days Equal Employment Opportunity
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf
Privacy Notice
Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf
How this job compares
Set against the 435 open Utilization Management jobs on Olive Jobs, counted November 6, 2026.
- Pay
- This posting$111–173K/yr
- US median$142–294K/yr268 salary ranges
This range's midpoint, $142K, is 27% below the US median midpoint ($194K) — in the lowest quarter of Utilization Management salary ranges across the US.
- Openings
- Olive Jobs lists 37 open Utilization Management jobs in California and 435 across the US. 21% of them nationwide are listed as remote or flexible.
- Hiring the most in California
- Kaiser Permanente5 open
- Sutter Health4 open
- Highmark Health3 open
- Experience
- This posting asks for at least 5 years of experience; Utilization Management postings that state a minimum ask for 5 years at the median (400 postings).
- Education
- 192 of the 435 open Utilization Management jobs (44%) ask for a bachelor's degree or higher.
Counted across the open, public US postings on Olive Jobs on November 6, 2026. Pay medians are the middle values of the low ends and of the high ends of postings that list both ends of a range in the same cadence (a yearly salary or an hourly rate); a range's midpoint is halfway between its ends. Pay and experience figures resting on fewer than 20 postings are left out.
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