Utilization Management Manager (CA Licensed)

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 Manage programs, processes and staff to meet current strategic needs and to anticipate future strategic changes Manage the development, implementation, and updates for the approval process of the Utilization Management Plan Analyze and monitor quality, cost reimbursement and utilization trends Identify opportunity areas, develop activities and recommend action plans for issue resolution Oversee inpatient and outpatient utilization management programs to ensure (1) cost-effective use of patient care resources and case delivery at the most appropriate level; (2) collaboration with the medical staff on resource utilization issues; and (3) compliance with utilization-related private contracts, all regulating agencies, and applicable federal and state regulatory mandates General Provide management for assigned engagements, staff and activities Understands opportunities to improve performance as compared to industry standard/ best practice Manages activities outlined in Clinical Management transformation engagement(s) Supports organizational improvement in performance of key clinical operations metrics, organization compliance and quality outcomes Implement recommended department structure changes to ensure appropriate coverage, optimized efficiency and improved performance Act in interim leadership capacity to provide supervision and oversight for Client clinical teams and activities (clinical management, utilization management, quality and care management/disease management) in a direct supervisory model Act as “Co-Sourced” leader to identify opportunities to improve workflow, generate accurate and high quality productivity, support organizational compliance with requirements and deliver reductions in associated costs with improvement in organizational quality performance in collaboration with Client operations leads, care management staff and co-sourced leaders and teams Develop and mentor UM staff Manage staff performance providing performance feedback, managing direct reports and performing personnel actions in accordance with policy and procedure Responsible for coordinating/ facilitating education of physicians, staff, members and families related to the clinical management processes Acts as liaison to facilitate communication and collaboration between all care partners based on the Client Model of Care Works closely with senior management and medical director(s) to ensure interdisciplinary collaboration necessary to effectively deploy clinical strategies and promote efficient operations Develops and delivers staff training and in-services Develops and deploys management reporting, if indicated, to support monitoring and improvement of performance for discipline specific identified/ tracked key performance indicators, implementing plans for improvement as necessary Responsible for the engagement 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 Collaborate with corporate quality, to ensure standardization of NCQA program requirements to support Client accreditation and recognition Promote interdisciplinary collaboration, foster teamwork and champion service excellence Uses data to drive decisions, plan, and implement performance improvement strategies for Client Clinical Management activity Position Qualifications: Competencies: Strong Communication – oral and written Flexibility and willingness to adapt to changing expectations Data analysis and problem solving Change Management Principles Leading and managing teams Delivering results aligned to key metrics and success criteria Experience: Bachelors Degree in Nursing Registered Nurse with current unencumbered California license required; Compact licensed preferred Minimum of two years of progressive utilization management experience 3+ years of experience in a clinical leadership position in Managed Care environment Experience working with disadvantaged populations preffered Knowledge of health disparities and community resources highly desired Experience working with related legal and regulatory requirements required Demonstrated ability to motivate performance with successful outcomes 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 Time Zone: Mountain or Pacific Other Information: Expected Hours of Work: Friday 8 am – 5 pm; with ability to adjust to Client schedules as needed Travel: May be required, as needed by Client Direct Reports: None Salary Range: $118,000 – $173,000 EEO Statement: It is Clearlink Partners’ 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.