CareSource · 4 hours ago
Team Lead, Clinical Care Review - R11259
Indiana, United States
Full-time
Onsite
Mid, Senior Level
$72K/yr - $116K/yr
1+ years expCareSource is a healthcare management company, and they are seeking a Team Lead for Clinical Care Review. The role involves overseeing the CCR team, ensuring quality performance, and managing healthcare service delivery effectively.
Health CareMedicalNon Profit
Responsibilities
Provide direct oversight of 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
Qualification
Required
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 (i.e. Licensed Professional Counselor (LPC), Licensed Clinical Social Worker (LCSW), etc.) is required
Basic computer skills
Basic proficiency in Microsoft Word and Excel
Communication skills
Management skills
Prior supervisory skills
Ability to work independently and within a team environment
Attention to detail
Familiarity of the healthcare field
Critical listening and thinking skills
Training/teaching skills
Negotiation skills/experience
Proper grammar usage
Time management skills
Proper phone etiquette
Customer service oriented
Decision making/problem solving skills
Leadership experience and skills
Preferred
Minimum of five (5) years clinical experience preferred
Certified Care Manager experience is preferred
Compact RN license or Multi-state Counselor/Social Worker licensure is preferred
MCG Certification preferred
Benefits
In addition to base compensation, you may qualify for a bonus tied to company and individual performance.
Substantial and comprehensive total rewards package.
Company
CareSource
CareSource provides managed care services to Medicaid beneficiaries.
1001-5000 employees
H1B Sponsorship
CareSource has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (9)
2024 (39)
2023 (35)
2022 (22)
2021 (37)
2020 (28)
Funding
Current Stage
Late StageLeadership Team
Erhardt Preitauer
President & Chief Executive Officer
Larry Smart
Chief Financial Officer
Recent News
Dayton Daily News
2025-12-17
Dayton Daily News
2025-11-19
Company data provided by crunchbase