Utilization Management Supervisor at UC San Francisco in San Francisco, CA

Job description

The Utilization Management Supervisor reports to the Assistant Director of Utilization Management and serves in a dual capacity as both a working supervisor and clinical utilization management professional. Approximately 50% of the role is dedicated to direct utilization management activities, including medical necessity review and level-of-care determinations, with the remaining 50% focused on supervision, staff development, and operational oversight of the Utilization Management team. In collaboration with clinical and administrative leadership, this position supports the design, implementation, and continuous improvement of utilization management processes that promote efficient patient throughput, appropriate resource utilization, and high-quality patient care. The Supervisor utilizes data and performance metrics—including hospital capacity, length of stay, and denial trends—to monitor operations, identify opportunities for improvement, and drive initiatives that enhance clinical, operational, and financial outcomes. This role also ensures the consistent application of medical necessity criteria, regulatory requirements, and payer guidelines, while supporting compliance with accreditation standards and organizational goals. Department Overview: The UCSF Health Utilization Management Department is an integral component of the multidisciplinary care team, comprised of expert clinicians and staff dedicated to advancing health through excellence, innovation, and patient-centered care. In alignment with UCSF Health’s mission and commitment to health equity, the department promotes timely access to appropriate services and resources across the continuum of care. Consistent with Joint Commission standards and regulatory requirements, the Utilization Management Department evaluates the medical necessity, appropriateness, level of care, and efficiency of services, treatments, procedures, and care settings. These activities support safe, high-quality, and cost-effective care, ensure appropriate use of hospital resources, and promote continuity and coordination of care. The Utilization Management Supervisor provides operational and clinical oversight of case management staff, including training, mentorship, and workflow coordination. This role ensures the accurate application of medical necessity criteria, payer guidelines, and regulatory standards, while supporting compliance with accreditation requirements. The Supervisor monitors caseloads for quality and consistency, facilitates resolution of complex and escalated cases, and leads process improvement efforts to enhance clinical outcomes, operational efficiency, and revenue integrity. % of time Essential Function (Yes/No) Key Responsibilities (To be completed by Supervisor) 50 Yes Working Supervisor / Staffing Support Maintains comprehensive working knowledge of all staff roles and functions; provides direct operational support by performing these duties as needed to address staffing gaps, ensure continuity of operations, and meet departmental productivity and quality expectations. 20 Yes Leadership & Human Resources Management Supervises staff, including hiring, onboarding, performance evaluations, disciplinary actions, and staff development. Ensures effective orientation, training, mentoring, and ongoing competency validation for team members. Promotes professional development and facilitates access to continuing education and training opportunities. 10 Yes Operational Oversight Oversees and coordinates daily utilization management operations, including staff scheduling, workload distribution, and resolution of operational or system issues to ensure efficient and continuous workflow. Serves as a clinical and operational resource, advising on work methods and supporting complex cases and escalated issues. Implements and evaluates new methods, systems, and processes to improve utilization management performance and efficiency. 10 Yes Care Coordination & Interdisciplinary Leadershi