Utilization Review Manager (Contra Costa Health Plan) Salary $195,039.12 - $237,071.27 Annually Location Martinez, CA Job Type Permanent Full-Time Job Number VWHG-2025A Department Health Services - Only Opening Date 07/16/2025 Closing Date Continuous FLSA Exempt Bargaining Unit ZA Description Benefits Questions The Position Re-Announcement*****Open Until Filled*Why Join Contra Costa County Health Services?The Contra Costa Health Department is seeking to fill one (1) Utilization Review Manager position in Contra Costa Health Plan, located in Martinez, CA. Contra Costa Health Plan (CCHP) is a mission-driven, county-operated managed care organization delivering high-quality health coverage to more than 250,000 members across Medi-Cal, commercial, and beginning in 2026, Medicare-Medi-Cal (D-SNP) lines of business. We are seeking a strategic, experienced, and collaborative Utilization Review Manager to lead our Utilization Management Department across all lines of business. This is a pivotal leadership opportunity at a critical moment in CCHP's growth and transformation. With increasing regulatory expectations from the Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), and Centers for Medicare and Medicaid Services (CMS), and the implementation of new care models under CalAIM and the upcoming Medicare and Medi-Cal Dual Special Needs Plan (D-SNP), regulatory compliance is more critical than ever. The Utilization Review Manager will be responsible for leading a team of clinical and administrative staff to ensure timely, compliant, and member-centered utilization management processes.We are looking for someone who:Has demonstrated experience leading utilization review and prior authorization functions within a managed care or health system environmentUnderstands federal and state regulatory frameworks, including DHCS, DMHC, CMS, and NCQA standardsIs an effective people leader who supports staff development, performance management, and cross-functional collaborationCan balance strategic vision with operational detail, helping translate evolving regulatory guidance into real-time implementationIs comfortable in fast-paced, dynamic environments and has the flexibility to adapt processes and policies as the organization evolvesWhat you will typically be responsible for:Managing and monitoring day-to-day clinical review operations and authorizationsLeading the development and implementation of utilization management policies and workflowsEnsuring turnaround time compliance and accuracy in decision-making and member/provider notificationsPreparing for and responding to audits, including CMS, DMHC, and delegated UM reviewsCollaborating with internal departments and external providers to support coordinated and efficient member careDeveloping reports and data tools that drive insights and accountabilityInterviewing, hiring, orienting, evaluating, counseling, and recommending discipline of staffSupervising and training staffA few reasons why you might love this job:You are passionate about public service and improving care for vulnerable populationsYou thrive in a mission-driven organization focused on innovation and continuous improvementYou enjoy mentoring staff and shaping a high-performing teamYou are excited by building systems and helping shape the foundation for new programs like D-SNPA few challenges you might face in this job:You will be expected to navigate complex regulatory environments and shifting program requirementsThe organization is in a period of transformation, and legacy processes may require redesign and improvementBalancing urgent operational demands with long-term strategic planning can be difficultCompetencies Required:Analyzing & Interpreting Data: Drawing meaning and conclusions from quantitative or qualitative dataDecision Making: Choosing optimal courses of action in a timely mannerDelivering Results: Meeting organizational goals and customer expectations and making decisions that produce high-quality results by applying technical knowledge, analyzing problems, and calculating risksAttention to Detail: Focusing on the details of work content, work steps, and final work productsSelf-Management: Showing personal organization, self-discipline, and dependabilityWriting: Communicating effectively in writingCustomer Focus: Attending to the needs and expectations of customersLeadership: Guiding and encouraging others to accomplish a common goalDriving Results: Demonstrating concern for achieving or surpassing results against an internal standard of excellence To read the complete job description, please click here. The eligible list established from this recruitment may be used to fill future openings for up to six (6) months. Minimum Qualifications License Required: Candidates must possess and maintain throughout the duration of employment: a current, valid, and unrestricted license as a Registered Nurse issued by the California Board of Registered Nursing. Applicants are required to attach a copy of their license to their application. Education: Possession of a bachelors degree in nursing from an accredited college or university. Experience: Three (3) years of full-time, or its equivalent, experience as a Registered Nurse in a managed care organization (i.e. HMO), two (2) years of which must have included experience as a Utilization Review Nurse, Discharge Planner, or Case Management Nurse, one (1) year of which must have been in a supervisory capacity. Substitution: Two (2) additional years in a Nurse Supervisor capacity may be substituted for the Bachelors degree. A Masters Degree in nursing, hospital or health care administration or a closely related field may be substituted for one (1) year of experience as a Registered Nurse. No substitution is allowed for the required one (1) year of supervisory experience. Selection Process Application Filing and Evaluation: Applicants will be required to complete a supplemental questionnaire at the time of application. Applications will be evaluated to determine which candidates will move forward in the next phase of the recruitment process.Training & Experience Evaluation: At the time of filing, candidates will be required to complete a supplemental questionnaire, which will be used for the training and experience evaluation. Candidates who clearly demonstrate that they possess the minimum qualifications will have their training and experience evaluated. The responses to the supplemental questions, at the time of filing, will be evaluated to determine each candidates relevant education, training, and/or experience as presented on the application and supplemental questionnaire. (Weighted 100%)The Human Resources Department may change the examination steps noted above in accordance with the Personnel Management Regulations and accepted selection practices. CONVICTION HISTORYAfter you receive a conditional job offer, you will be fingerprinted, and your fingerprints will be sent to the California Department of Justice (DOJ) and the Federal Bureau of Investigation (FBI). The resulting report of your conviction history (if any) will be used to determine whether the nature of your conviction conflicts with the specific duties and responsibilities of the job for which you have received a conditional job offer. If a conflict exists, you will be asked to present any evidence of rehabilitation that may mitigate the conflict, except when federal or state regulations bar employment in specific circumstances. Having a conviction history does not automatically preclude you from a job with Contra Costa County. If you accept a conditional job offer, the Human Resources department will contact you to schedule a fingerprinting appointment. DISASTER SERVICE WORKERAll Contra Costa County employees are designated Disaster Service Workers through state and local law. Employment with the County requires the affirmation of a loyalty oath to this effect. Employees are required to complete all Disaster Service Worker-related training as assigned, and to return to work as ordered in the event of an emergency. EQUAL EMPLOYMENT OPPORTUNITYIt is the policy of Contra Costa County to consider all applicants for employment without regard to race, color, religion, sex, national origin, ethnicity, age, disability, sexual orientation, gender, gender identity, gender expression, marital status, ancestry, medical condition, genetic information, military or veteran status, or other protected category under the law. To find more information on Benefits offered by Contra Costa County, please go to https://www.contracosta.ca.gov/1343/Employee-Benefits 01 The purpose of the questionnaire is to provide applicants the opportunity to elaborate on their experience, education, and training for the Volunteer Program Coordinator position and to assist Human Resources staff in assessing each applicants qualifications. Your responses to the questionnaire will be used to better understand your relevant experience, education, and training to determine which applicants will be invited to participate in the next step of the recruitment process. Do not answer any of the questions by indicating "see attached application or see resume." I understand 02 Do you possess a current, valid, and unrestricted license as a Registered Nurse issued by the California Board of Registered Nursing? Yes, AND I have attached a copy to my application No 03 Select the option that best describes your education? Please note: candidates are required to attach a copy of their degree or transcripts to the application. Applications without this documentation will not be accepted. Masters in Nursing, Hospital or Health Care Administration Bachelors in Nursing, Hospital or Health Care Administration Associates in Nursing None 04 How many years of experience do you have as a Registered Nurse in a managed-care setting (i.e. HMO)? Less than three (3) years of experience Three (3) years but less than four (4) years of experience Four (4) years but less than five (5) years of experience Five (5) years but less than (6) years of experience More than six (6) years of experience 05 How many years of full-time experience do you have as a Registered Nurse in a supervisory capacity in a managed-care setting (i.e. HMO)? Less than one (1) year of experience One (1) year but less than three (3) years of experience Three (3) years but less than five (5) years of experience Five (5) years but less than seven (7) years of experience More than seven (7) years of experience 06 How many years of full-time experience do you have as a Utilization Review Nurse, Discharge Planner, or Case Management Nurse in a managed-care setting (i.e. HMO)? Less than one (1) year of experience One (1) year but less than three (3) years of experience Three (3) years but less than five (5) years of experience More than five (5) years of experience 07 How many years of full-time experience do you have reviewing patient treatment plans to ensure adherence to established criteria and standards? Less than one (1) year of experience One (1) year but less than three (3) years of experience Three (3) years but less than five (5) years of experience More than five (5) years of experience 08 How many years of experience do you have interviewing, selecting, hiring, orienting, evaluating, and recommending discipline of staff? Less than one (1) year of experience One (1) year but less than three (3) years of experience Three (3) years but less than five (5) years of experience More than five (5) years of experience 09 By checking this box, I am confirming that all statements made in this supplemental questionnaire and on the application are accurate and true; and I understand that misstatements or omissions of material facts will result in being rejected from this recruitment process or released from future employment with Contra Costa County. I understand Required Question Employer County of Contra Costa Phone exams@cchealth.org