Team Lead - Clinical Care Review - Behavioral Health - RN - MSL

CareSource Management Group Company

Job Overview

Location

Remote

Job Type

Full-time

Full Job Description

📋 Description

• Provide direct oversight of Clinical Care Review (CCR) employees and oversee day-to-day workflow within the CCR team
• Ensure all direct reports are performing at minimum quality and productivity standards or better
• Understand complexities of health conditions and services
• Develop plan for management of workload after analyzing trends and act as advocate for CCR team
• Provide feedback, guidance, orientation, training and ongoing resources to CCRs and pre-authorization team
• Standardize activity and outcome reporting for department initiatives and programs including documentation required by the State and accrediting bodies
• Responsible for utilization review and discharge planning activities for CareSource members
• Monitor and ensure appropriate delivery of healthcare services in cost-effective manner
• Assist manager and director in development of process improvement activities and refining of processes that facilitate cost-effective utilization and appropriate levels of care
• Act as a liaison between Care Management, Claims, Enrollment, Customer Service and other areas as needed to assist in problem resolutions
• Perform audits of CCR team members to ensure compliance with CareSource policies, processes, regulatory requirements, NCQA utilization review guidelines and standards, and URAC review guidelines
• Provide input into CCR team evaluations and assist with development of team goals
• Design and present UM informational meetings as needed
• Responsible for attending state hearings as necessary
• Perform any other job duties as requested

🎯 Requirements

• Graduate level degree as a mental health professional or Bachelor of Science degree in Nursing or equivalent
• One year of Utilization Management/Utilization Review experience required
• Minimum of five (5) years clinical experience preferred
• Certified Care Manager experience is preferred

🏖️ Benefits

• Current, unrestricted license as a Registered Nurse (RN) or a mental health professional (i.e. Licensed Professional Counselor (LPC), Licensed Clinical Social Worker (LCSW), etc.) is required
• Compact RN license or Multi-state Counselor/Social Worker licensure is preferred
• MCG Certification preferred
• General office environment; may be required to sit or stand for extended periods of time
• $72,200.00 - $115,500.00
• Salary
• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business

Skills & Technologies

Senior

Remote

Degree Required

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CareSource Management Group Company

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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.

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