Utilization Management RN - Behavioral Health (CA Licensed)

Job Description

Job Description

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

• Determine appropriateness of services through the application and evaluation of medical guidelines, benefit determinations and compliance with state mandated regulated based on approved criteria (MCG, InterQual, etc.)
• Perform 15-30 reviews per day
• Performs initial and concurrent review of inpatient admissions
• Performs reviews for outpatient surgeries, and ancillary services
• Concludes medical necessity and appropriateness of services using clinical review criteria
• Collaborate with Medical Director(s) for appropriate referrals, complex cases and adverse determinations to ensure timely access to medically necessary / appropriate services
• Accurately documents all review determinations, contacting providers and members according to established requirements and timeframes

General

Position Qualifications :

Competencies :

Experience :

Physical Requirements :

Time Zone : Mountain or Pacific

Other Information :

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. #ZR

Company Description

Clearlink empowers Managed Care Organizations (MCOs) to establish and optimize clinically focused operations. Our specialized expertise spans population health, quality improvement, utilization management, care management, appeals and grievances, and HRA compliance, as well as market expansion through strategic product and network development initiatives.

By integrating advanced technology—from selection to implementation—and offering delegated solutions through Business Process as a Service (BPaaS), we help organizations achieve recurring, sustainable clinical excellence. This approach delivers measurable improvements in healthcare spend, operational efficiency, and member outcomes.

Company Description

Clearlink empowers Managed Care Organizations (MCOs) to establish and optimize clinically focused operations. Our specialized expertise spans population health, quality improvement, utilization management, care management, appeals and grievances, and HRA compliance, as well as market expansion through strategic product and network development initiatives.\r\n\r\nBy integrating advanced technology—from selection to implementation—and offering delegated solutions through Business Process as a Service (BPaaS), we help organizations achieve recurring, sustainable clinical excellence. This approach delivers measurable improvements in healthcare spend, operational efficiency, and member outcomes.