Nurse Manager II, UM / Discharge Planning

Position Title: Nurse Manager II, UM / Discharge Planning (Confidential Client)
Location: San Francisco, CA | Onsite
Employment Type: Permanent | Full-Time

Compensation

• Salary: $239,000 - $259,000/yr

Company Overview (Confidential)

Our client is a leading integrated healthcare delivery system serving millions of members across multiple states. As one of the largest not-for-profit health plans in the nation, they are committed to providing high-quality, affordable care while advancing healthcare innovation and patient outcomes.

Position Summary

We are seeking an experienced Nurse Manager II to oversee Utilization Management and Discharge Planning operations at our San Francisco location. This leadership role will manage a team of clinical nurses and case managers, ensuring effective care coordination, appropriate resource utilization, and seamless patient transitions. You will play a critical role in improving patient outcomes while optimizing operational efficiency and compliance with regulatory standards.

Key Responsibilities

• Lead, mentor, and supervise a team of UM nurses and discharge planning specialists
• Develop and implement policies and procedures for utilization management and discharge planning processes
• Monitor team performance metrics, including review turnaround times, denial rates, and patient satisfaction scores
• Ensure compliance with federal and state regulations, accreditation standards, and organizational policies
• Collaborate with clinical leadership, case management, and hospital partners to optimize care coordination and reduce readmission rates
• Conduct quality audits and provide feedback to team members on clinical reviews and documentation
• Participate in interdepartmental committees and initiatives focused on care improvement and operational efficiency
• Budget management and resource allocation for departmental operations

Required Qualifications

• Bachelor's degree in Nursing (BSN) or equivalent from an accredited institution
• Current, unencumbered Registered Nurse (RN) license in California
• Minimum 5+ years of clinical nursing experience
• Minimum 2+ years of management or supervisory experience in healthcare
• Demonstrated experience in utilization management, discharge planning, or case management
• Strong knowledge of healthcare regulations, accreditation requirements (NCQA, URAC), and payer guidelines
• Excellent leadership, communication, and interpersonal skills
• Proficiency with electronic health records (EHR) and healthcare information systems

Preferred Qualifications

• Master's degree in Nursing, Business Administration, or Healthcare Management
• Certification in Case Management (CCM) or Utilization Management (CCUE)
• Experience working in a large integrated healthcare system or managed care environment
• Knowledge of quality improvement methodologies (Lean, Six Sigma)

Must-Have Requirements

• Valid California RN license (non-negotiable)
• Proven management experience with demonstrated success leading clinical teams
• Direct experience with utilization management and/or discharge planning functions