Utilization Review Manager; Contra Costa Health Plan

Overview

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.

• Managing and monitoring day-to-day clinical review operations and authorizations
• Leading the development and implementation of utilization management policies and workflows
• Ensuring turnaround time compliance and accuracy in decision-making and member/provider notifications
• Preparing for and responding to audits, including CMS, DMHC, and delegated UM reviews
• Collaborating with internal departments and external providers to support coordinated and efficient member care
• Developing reports and data tools that drive insights and accountability
• Interviewing, hiring, orienting, evaluating, counseling, and recommending discipline of staff
• Supervising and training staff

• License
  
  Required:
  
  Possess and maintain throughout employment a current, valid, and unrestricted license as a Registered Nurse issued by the California Board of Registered Nursing.
• Education: Possession of a bachelor's 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 include experience as a Utilization Review Nurse, Discharge Planner, or Case Management Nurse, and 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 Bachelor's degree. A Master’s Degree in nursing, hospital or health care administration or a closely related field may be substituted for one (1) year of RN experience. No substitution is allowed for the required one (1) year of supervisory experience.

The Human Resources Department may change the examination steps noted above in accordance with the Personnel Management Regulations and accepted selection practices.

• CONVICTION HISTORY: After you receive a conditional job offer, you will be fingerprinted. The resulting report will be used to determine whether a conflict exists with the duties of the job. Having a conviction history does not automatically preclude employment.
• DISASTER SERVICE WORKER: All Contra Costa County employees are designated Disaster Service Workers and must complete related training as assigned.
• EQUAL EMPLOYMENT OPPORTUNITY: Contra Costa County considers all applicants without regard to protected characteristics.

Applicants are required to attach a copy of their license to their application.