Utilization Management Manager (CA Licensed)

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

Back Utilization Management Manager (CA Licensed)

Managed Care Remote Direct Hire Aug 22, 2026

Company Description

Clearlink Partners is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management services and market expansion initiatives for Managed Medicaid, Medicare Advantage, Special Needs Plans, complex care populations, and risk-adjusted entities.

We support organizations as they navigate a dynamic healthcare ecosystem by helping them manage risk, optimize healthcare spend, improve member experience, accelerate quality outcomes, and promote health equity.

Position Responsibilities

Specific

• Design utilization management programs, processes and workflows to meet operational goals and anticipate future strategic needs
• Evaluate ability to automate and streamline standard work
• Analyze and monitor quality, cost reimbursement and utilization trends.
• Support system migration planning, preparation, and execution to ensure a seamless operational transition.
• Develop and oversee inpatient and outpatient utilization management programs to ensure
  • Cost-effective use of patient care resources
  • Case delivery at the most appropriate level
  • Collaboration with the medical staff on resource utilization issues
  • Compliance with utilization-related private contracts, all regulating agencies,and applicable federal and state regulatory mandates.

General

• Provide support for health plan market/ product level operational oversight, management and performance improvement
• Leverage industry expertise and knowledge to provide high value consulting and advisory services
• Deliver integrated solutions in support of client goals and engagements.
• Provide delivery assurance support for engagements with assigned clients
• Support engagements ensuring completion of contracted services
  • Create and/ or manage to project plans
  • Prepare materials for presentation to Client executives
  • Facilitate and inform key decisions through the use of data and industry best practice sharing
• Deliver concise, clear interpersonal communication to both internal and external audiences
• Facilitate streamlined exchange of information with engagement manager and client organization partner(s)
• Leverage proven methodologies and best practices in support of individual account strategies/ client plans
• Establish goals and track progress to ensure achievement
• Act in interim leadership capacity to provide supervision and oversight for teams and activities in a direct supervisory model
  • Identify opportunities to improve workflow, generate accurate, high-quality productivity, support organizational compliance with requirements and deliver reductions in associated costs with improvement in organizational quality performance in collaboration with Client leaders
• Develop or update policies and procedures as required to support business needs and requirements
• Identify opportunities to streamline and/ or automate workflows
• Manage and develop staff to reach established engagement goals, deliverables and KPIs
• Adapt processes, approach, plan and/ or activities in real time to ensure critical path activities are achieved
• Support account management relationships with key client decision makers
• Develop and deploy management reporting, if indicated, to support monitoring and improvement of performance, implementing plans for improvement as necessary
• Responsible for ensuring quality, maintaining appropriate resources, competency training and education of staff
• Responsible for approving and managing day to day engagement resourcing/ time and attendance as an Engagement Manager
• Oversee compliance with internal client related audits, support Client preparation for external audits and surveys

Position Qualifications

Competencies

• Experience managing complex work in challenging environments through the alignment of resources and prioritization of efforts to ensure on time, in scope project and/ or strategic delivery.
• Managed care industry knowledge in operations, costs, requirements, performance and outcomes
• Demonstrated ability to work across and apply best practices to multiple Lines of Business (LOBs); Covered California experience strongly preferred.
• Hands-on leader with an owner/operator mindset who actively supports the team and is willing to step into the queue as needed to ensure operational success.
• Strong knowledge of NCQA standards, with the ability to translate requirements into streamlined workflows, operational efficiencies, and process improvements.
• Collaborate closely with UM leadership and the Vice President of Utilization Management to drive operational enhancements and support implementation of the new Prior Authorization (PA) grid.
• Proven ability to identify operational challenges, develop effective solutions, and drive resolution in a fast-paced environment.
• Product/ market operational experience in Commercial, Medicare, Medicare Advantage, Medicaid or associated lines of business
• Understanding of legal and regulatory frameworks, healthcare administration models, and internal audit procedures.
• Understanding of key regulations, frameworks, accreditation and oversight bodies to ensure compliance with complex regulatory structures.
• Knowledge of project management principles, methods, and techniques
• Ability to organize, and manage multiple competing priorities
• Strong communication skills both written and oral
• High proficiency with core office software (Excel, Word, and PowerPoint). Visio skills preferred

Experience

• Registered Nurse with current unencumbered California license.
• 3+ years of California Managed Medicaid
• Experience in Quality Assurance (QA) and performance improvement initiatives, with a focus on continuous process optimization and outcomes improvement.
• 2+ years progressive experience in managed care at the Manager level or equivalent level, specifically in utilization management preferably in a government payor environment
• Bachelor’s Degree preferred, will accept equivalent experience in managed care environment

Physical Requirements

• Must be able to sit in a chair for extended periods of time
• Must be able to speak so that you are able to accurately express ideas by means of the spoken word
• Must be able to hear, understand, and/or distinguish speech and/or other sounds in person, via telephone/cellular phone, and/or electronic devices
• Must have ample dexterity which allows entering of text and/or data into a computer or other electronic device by means of a keyboard and/or mouse
• Must be able to clearly use sight so that you are able to detect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, and/or assess data or other information types
• Must be able to fluently communicate both verbally and in writing using the English language
• Must be able to engage in continuous social interaction, successfully manage stressful high conflict situations, and balance multiple duties, expectations and responsibilities simultaneously

Time Zone

Mountain or Pacific

Other Information

• Expected Hours of Work: Monday - Friday; 8am – 5 pm PST; with ability to adjust to Client schedules as needed
• Travel: May be required, as needed by Client
• Direct Reports: None
• Salary Range: $100,000 - $150,000

EEO Statement

It isClearlinkPartners’ policy to provide equal employment opportunity to all employees and applicants without regard to race, sex, sexual orientation, color, creed, religion, national origin, age, disability, marital status, parental status, family medical history or genetic information, political affiliation, military service or any other non-merit-based factor in accordance with all applicable laws, directives and regulations of Federal, state and city entities. This salary range reflects the minimum and maximum target wage for new hires of this position across all US locations. Individual pay will be influenced by Experience, Education, Specialized Soft Skills, and/or Geographic location.