Clinical Care Reviewer II - Multi State License - RN - Behavioral Health

CareSource Management Group Company

Job Overview

Location

Remote

Job Type

Full-time

Full Job Description

📋 Description

• Review medical necessity for behavioral health services to determine appropriateness of authorization
• Assist with discharge planning activities for outpatient services, home health services, and care coordination
• Identify, document, communicate, and coordinate care with collaborative partners to facilitate transition to appropriate level of care
• Engage with medical director when additional clinical expertise is needed
• Maintain knowledge of state and federal regulations, including State Contracts and Provider Agreements, benefits, and accreditation standards
• Identify and refer quality issues to Quality Improvement
• Identify and refer appropriate members for Care Management
• Provide guidance to non-clinical staff
• Provide guidance and support to LPN staff
• Attend medical advisement and State Hearing meetings, as requested
• Assist Team Leader with special projects or research, as requested
• Perform any other job related duties as requested

🎯 Requirements

• Current, unrestricted Registered Nurse (RN) Licensure or Licensed Social Worker (LSW) required
• Bachelor of Science (B.S) in Social Work required
• Three (3) years clinical experience required
• MCG Certification is required or must be obtained within six (6) months of hire required

🏖️ Benefits

• Hourly compensation range: $62,700.00 - $100,400.00
• Comprehensive total rewards package
• Equal Opportunity Employer commitment

Skills & Technologies

Remote

Degree Required

Ready to Apply?

Apply Externally

You will be redirected to an external site to apply.

CareSource Management Group Company

Visit Website

About CareSource Management Group Company

CareSource is a nonprofit, multi-state managed care organization headquartered in Dayton, Ohio. Founded in 1989, it administers Medicaid, Medicare Advantage, and Marketplace health plans serving over two million members in Ohio, Kentucky, Indiana, West Virginia, and Georgia. The company focuses on improving health outcomes for low-income and vulnerable populations through integrated care management, behavioral health services, and social determinants programs.

View Company Profile

Get more remote jobs like this

Subscribe to the weekly newsletter for similar remote roles and curated hiring updates.

Weekly remote jobs and featured talent.

No spam. Only curated remote roles and product updates. You can unsubscribe anytime.