CareSource
1001 - 5000 employees
Founded 30+ years
⚕️ Healthcare Insurance
Healthcare Insurance
CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.
Clinical Care Reviewer II – Behavioral Health
Job not on LinkedIn
🔥 0 minutes ago
🇺🇸 United States – Remote
💵 $62.7k - $100.4k / year
⏰ Full Time
🟡 Mid-level
🟠 Senior
🔍🏥 Medical Reviewer
🦅 H1B Visa Sponsor
📊 Check your resume score for this job
Improve your chances of getting an interview by checking your resume score before you apply.
CareSource
1001 - 5000 employees
Founded 30+ years
⚕️ Healthcare Insurance
Healthcare Insurance
CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.
📋 Description
• Process medical necessity reviews for authorization for behavioral health care services • Assist with discharge planning activities • Care coordination for members • Engage with medical director when additional clinical expertise is needed • Maintain knowledge of state and federal regulations • Identify and refer quality issues to Quality Improvement • Provide guidance to non-clinical staff • Attend medical advisement and State Hearing meetings as requested • Assist Team Leader with special projects or research
🎯 Requirements
• Associates of Science (A.S) in Nursing required or Bachelor of Science (B.S) in Social Work required or Master's degree in a mental health related field (Psychology, Counseling Psychology, Marriage or Family Therapy) required • Three (3) years clinical experience required • Utilization Management/Utilization Review experience preferred • Medicaid/Medicare/Commercial experience preferred
🏖️ Benefits
• Comprehensive total rewards package • Potential for a bonus tied to company and individual performance
Apply NowSimilar Jobs
🕒 Yesterday
Clinical Record Reviewer focused on improving home health documentation and compliance for patient care. Collaborating with clinical teams to enhance performance through quality review processes.
🕒 2 days ago
Clinical Review Specialist providing clinical review support to assist with client demand. Responsible for medical record reviews and ensuring compliance with payer guidelines.
🕒 July 10
Clinical RN Chart Reviewer performing clinical reviews of medical records for claims coding accuracy. Role involves auditing NICU claims and ensuring compliance with coding standards and guidelines.
🕒 July 5
New England Life Care
201 - 500
Clinical Review Specialist conducting regular reviews for coverage in home infusion therapy company. Consulting with Medical Director, maintaining compliance, and ensuring high-quality care.
🇺🇸 United States – Remote
💵 $24 - $25 / hour
⏰ Full Time
🟡 Mid-level
🟠 Senior
🔍🏥 Medical Reviewer
🦅 H1B Visa Sponsor
🕒 June 29
Clinical Compliance Reviewer ensuring clinical documentation meets payer-specific insurance coverage. Supporting funding workflows and providing feedback to SLPs on compliance and quality.
