Utilization Management Manager; CA Licensed

Back Utilization Management Manager (CA Licensed)

Managed Care Remote Direct Hire Aug 22, 2026

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.

• 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.

• 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

• 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…