NEOGOV · 6 months ago
Utilization Review Manager (Contra Costa Health Plan)
Martinez, CA
Full-time
Onsite
Mid, Senior Level
$195K/yr - $237K/yr
3+ years expNEOGOV is seeking a Utilization Review Manager for the Contra Costa Health Plan located in Martinez, CA. The role involves leading the Utilization Management Department to ensure compliant and member-centered processes while navigating regulatory expectations and supporting clinical and administrative staff.
GovTechHuman ResourcesInformation TechnologySoftware
Responsibilities
Managing and monitoring day-to-day clinical review operations and authorizations
Leading the development and implementation of utilization management policies and workflows
Ensuring turnaround time compliance and accuracy in decision-making and member/provider notifications
Preparing for and responding to audits, including CMS, DMHC, and delegated UM reviews
Collaborating with internal departments and external providers to support coordinated and efficient member care
Developing reports and data tools that drive insights and accountability
Interviewing, hiring, orienting, evaluating, counseling, and recommending discipline of staff
Supervising and training staff
Qualification
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
Possession of a bachelor's degree in nursing from an accredited college or university
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
Preferred
Demonstrated experience leading utilization review and prior authorization functions within a managed care or health system environment
Understanding of federal and state regulatory frameworks, including DHCS, DMHC, CMS, and NCQA standards
Effective people leader who supports staff development, performance management, and cross-functional collaboration
Ability to balance strategic vision with operational detail, helping translate evolving regulatory guidance into real-time implementation
Comfortable in fast-paced, dynamic environments and has the flexibility to adapt processes and policies as the organization evolves
Company
NEOGOV
NEOGOV is the leading provider of workforce management software uniquely designed for the public sector, education, and public safety.
501-1000 employees
H1B Sponsorship
NEOGOV has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (13)
2024 (10)
2023 (10)
2022 (18)
2021 (14)
2020 (16)
Funding
Current Stage
Late StageTotal Funding
$700MKey Investors
Warburg Pincus
2025-07-28Secondary Market· $700M
2025-07-28Acquired
2021-06-02Private Equity
Leadership Team
Shane Evangelist
CEO
Brandon McDonald
Head Of Marketing
Recent News
Canada NewsWire
2025-11-14
2025-11-14
Government Technology US
2025-10-31
Company data provided by crunchbase