Team Lead, Clinical Care Review – Behavioral Health

🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $72.2k - $115.5k / year

⏰ Full Time

🟠 Senior

🦅 H1B Visa Sponsor

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

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

• Provide direct oversight of Clinical Care Review employees and oversee day-to-day workflow within the CCR team • Ensure direct reports meet minimum quality and productivity standards • Analyze health-condition and service complexities • Develop workload-management plans based on trend analysis and advocate for the CCR team • Provide feedback, guidance, orientation, training, and ongoing resources to CCRs and the pre-authorization team • Standardize activity and outcome reporting for department initiatives and programs, including documentation required by the State and accrediting bodies • Perform utilization review and discharge planning activities for CareSource members • Monitor appropriate, cost-effective delivery of healthcare services • Assist management and leadership with process-improvement activities and refining utilization and care-level processes • Liaise with Care Management, Claims, Enrollment, Customer Service, and other areas to resolve problems • Audit CCR team members for 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 team goals • Design and present utilization-management informational meetings • Attend state hearings as necessary • Perform other requested job duties

🎯 Requirements

• Graduate level degree as a mental health professional or Bachelor of Science degree in Nursing or equivalent years of relevant work experience is required • One year of Utilization Management/Utilization Review experience required • Current, unrestricted license as a Registered Nurse (RN) or a mental health professional (e.g., LPC, LCSW) is required • Minimum of five (5) years clinical experience preferred • Certified Care Manager experience preferred • Basic computer skills • Basic proficiency in Microsoft Word and Excel • Management skills • Prior supervisory skills • Ability to work independently and within a team environment • Familiarity with the healthcare field • Critical listening and thinking skills • Training/teaching skills • Negotiation skills/experience • Leadership experience and skills • Decision making/problem solving skills • Attention to detail • Time management skills • Proper grammar usage • Proper phone etiquette • Customer service orientation

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Substantial and comprehensive total rewards package • Total well-being support