Utilization Review Manager (Contra Costa Health Plan)

Salary : $187,537.56 - $227,953.08 Annually

Location : Martinez, CA

Job Type : Permanent Full-Time

Job Number : VWHG-2024B

Department : Health Services - Only

Opening Date : 11 / 27 / 2024

Closing Date : Continuous

FLSA : Exempt

Bargaining Unit : ZA

The Position

• Re-Announcement
• This is a continuous recruitment
• Qualified candidates are encouraged to apply immediately

Why Join Contra Costa County Health Services?

The Contra Costa Health Department is seeking to fill two (2) Utilization Review Manager positions in Contra Costa Health Plan's (CCHP) division, located in Martinez, CA.

The Utilization Review Manager plans, organizes, and supervises the activities of the unit staff, prepares the department for internal and external audits, conducts utilization management delegation audits, and develops policies and procedures for adherence to governmental and accredited agency standards. The Utilization Review Manager also oversees and participates in the development and implementation of effective and efficient standards, policies, protocols, processes, reports, and benchmarks that support and further enhance utilization management and timely access to care.

We are looking for someone who :

Analytical and data driven. You will be responsible for analyzing data to construct and implement action plans that will aid in improving performance standards.

Action-oriented and results-focused. You will need to take initiative and ensure tasks are completed in a timely and efficient manner.

Calm, collected, and level-headed. You will encounter pressing demands from multiple sources and will need to balance them.

Respectful and understands diversity. You will be working with a culturally and linguistically diverse population.

What you will typically be responsible for :

Interviewing, hiring, orienting, evaluating, counseling, and recommending discipline of staff

Supervising and training staff

Reviewing patient treatment plans to ensure adherence to established criteria and standards

A few reasons why you might love this job :

You will contribute to a dynamic organization that embraces creativity, learning, and support

You will gain experience in a broad range of healthcare obstacles

A few challenges you might face in this job :

You will work in a fast-paced environment requiring multitasking and the ability to prioritize

At times, you will encounter resource constraints

Competencies Required :

Decision Making : Choosing optimal courses of action in a timely manner

Delivering Results : Meeting organizational goals and customer expectations and making decisions that produce high-quality results by applying technical knowledge, analyzing problems, and calculating risks

Attention to Detail : Focusing on the details of work content, work steps, and final work products

Self-Management : Showing personal organization, self-discipline, and dependability

Writing : Communicating effectively in writing

Customer Focus : Attending to the needs and expectations of customers

Leadership : Guiding and encouraging others to accomplish a common goal

Driving Results : Demonstrating concern for achieving or surpassing results against an internal standard of excellence

To read the complete job description, please click The eligible list established from this recruitment may be used to fill future openings for up to six (6) months.

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

Training & Experience Evaluation : At the time of filing, candidates will be required to complete a supplemental questionnaire, which will be used for the training and experience evaluation. Candidates who clearly demonstrate that they possess the minimum qualifications will have their training and experience evaluated. The responses to the supplemental questions, at the time of filing, will be evaluated to determine each candidate's relevant education, training, and / or experience as presented on the application and supplemental questionnaire. (Weighted 100%)

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, and your fingerprints will be sent to the California Department of Justice (DOJ) and the Federal Bureau of Investigation (FBI). The resulting report of your conviction history (if any) will be used to determine whether the nature of your conviction conflicts with the specific duties and responsibilities of the job for which you have received a conditional job offer. If a conflict exists, you will be asked to present any evidence of rehabilitation that may mitigate the conflict, except when federal or state regulations bar employment in specific circumstances. Having a conviction history does not automatically preclude you from a job with Contra Costa County. If you accept a conditional job offer, the Human Resources department will contact you to schedule a fingerprinting appointment.

DISASTER SERVICE WORKER

All Contra Costa County employees are designated Disaster Service Workers through state and local law. Employment with the County requires the affirmation of a loyalty oath to this effect. Employees are required to complete all Disaster Service Worker-related training as assigned, and to return to work as ordered in the event of an emergency.

EQUAL EMPLOYMENT OPPORTUNITY

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.

To find more information on Benefits offered by Contra Costa County, please go to

The purpose of the questionnaire is to provide applicants the opportunity to elaborate on their experience, education, and training for the Volunteer Program Coordinator position and to assist Human Resources staff in assessing each applicant's qualifications. Your responses to the questionnaire will be used to better understand your relevant experience, education, and training to determine which applicants will be invited to participate in the next step of the recruitment process. Do not answer any of the questions by indicating "see attached application or see resume."

Do you possess a current, valid, and unrestricted license as a Registered Nurse issued by the California Board of Registered Nursing?

Select the option that best describes your education? Please note : candidates are required to attach a copy of their degree or transcripts to the application. Applications without this documentation will not be accepted.

How many years of experience do you have as a Registered Nurse in a managed-care setting (i.e. HMO)?

How many years of full-time experience do you have as a Registered Nurse in a supervisory capacity in a managed-care setting (i.e. HMO)?

How many years of full-time experience do you have as a Utilization Review Nurse, Discharge Planner, or Case Management Nurse in a managed-care setting (i.e. HMO)?

How many years of full-time experience do you have reviewing patient treatment plans to ensure adherence to established criteria and standards?

How many years of experience do you have interviewing, selecting, hiring, orienting, evaluating, and recommending discipline of staff?

By checking this box, I am confirming that all statements made in this supplemental questionnaire and on the application are accurate and true; and I understand that misstatements or omissions of material facts will result in being rejected from this recruitment process or released from future employment with Contra Costa County.

Required Question

Salary : $187,538 - $227,953