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CareSource · 1 day ago

Team Lead, Clinical Care Review

United States

Full-time

Remote

Mid, Senior Level

$72K/yr - $116K/yr

1+ years exp

CareSource is a healthcare organization focused on providing quality care and support. The Team Lead, Clinical Care Review is responsible for overseeing the Clinical Care Review team, ensuring quality performance, and managing day-to-day operations while advocating for the team and improving processes.

Health CareMedicalNon Profit

Comp. & Benefits

H1B Sponsor Likely

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

Utilization Management experienceRegistered Nurse licenseMental health professional licenseManagement skillsLeadership skillsCommunication skillsCritical thinking skillsBasic computer skillsMicrosoft Word proficiencyMicrosoft Excel proficiencyCustomer service orientedTraining skillsAttention to detailNegotiation skillsTime management skillsDecision making skills

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

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

You may qualify for a bonus tied to company and individual performance

Substantial and comprehensive total rewards package

Company

CareSource

Glassdoor3.8

CareSource provides managed care services to Medicaid beneficiaries.

Founded in 1989

Dayton, Ohio, USA

1001-5000 employees

https://www.caresource.com/

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 (30)

2024 (39)

2023 (35)

2022 (21)

2021 (37)

2020 (28)