Utilization Review Manager (Contra Costa Health Plan)

Utilization Review Manager

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 environment
• Understands federal and state regulatory frameworks, including DHCS, DMHC, CMS, and NCQA standards
• Is an effective people leader who supports staff development, performance management, and cross-functional collaboration
• Can balance strategic vision with operational detail, helping translate evolving regulatory guidance into real-time implementation
• Is comfortable in fast-paced, dynamic environments and has the flexibility to adapt processes and policies as the organization evolves

What you will typically be responsible for :

A few reasons why you might love this job :

A few challenges you might face in this job :

Competencies Required :

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 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 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 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 experience as a Registered Nurse. No substitution is allowed for the required one (1) year of supervisory experience.

Selection Process :

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

It 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.