Remote CA Utilization Management Manager (CA Licensed RN)

Clearlink Partners; United States; Remote; USD 100,000 - 150,000; Full time

Job summary

Clearlink Partners is seeking a Back Utilization Management Manager (CA Licensed) to lead UM program design and oversee QA, cost and quality improvements. This role operates in a remote, direct-hire capacity, serving managed care clients across the US.

The ideal candidate holds a California RN license, has 3+ years in California Managed Medicaid, and at least 2 years in a manager-level UM role, with strong NCQA knowledge and PM skills.

Qualifications

• Licensed California RN with current, unencumbered license.
• 3+ years of California Managed Medicaid experience.
• 2+ years at manager level in managed care / utilization management.
• Bachelor’s degree or equivalent experience in managed care.

Responsibilities

• Design utilization management programs, processes and workflows.
• Evaluate automation opportunities for standard work.
• Monitor quality, cost reimbursement and utilization trends.
• Support system migration planning and execution.
• Lead inpatient and outpatient utilization programs to optimize resource use and compliance.

Skills

Leadership

Communication

Project management

Stakeholder management

Quality focus

Education

Bachelor’s Degree

Tools

Excel

Word

PowerPoint

Visio

Job description

Clearlink Partners is seeking a Back Utilization Management Manager (CA Licensed) to lead UM program design and oversee QA, cost and quality improvements. This role operates in a remote, direct-hire capacity, serving managed care clients across the US.

The ideal candidate holds a California RN license, has 3+ years in California Managed Medicaid, and at least 2 years in a manager-level UM role, with strong NCQA knowledge and PM skills.