CareSource · 1 week ago
Clinical Care Reviewer II - Behavioral Health (LMHC, LICSW) Massachusetts only! - R11766
Massachusetts, United States
Full-time
Onsite
Mid Level
$63K/yr - $100K/yr
3+ years expCareSource is a healthcare organization seeking a Clinical Care Reviewer II – Behavioral Health. The role is responsible for processing medical necessity reviews for behavioral health care services and assisting with care coordination and discharge planning activities for members.
Health CareMedicalNon Profit
Responsibilities
Complete prospective, concurrent and retrospective review of Behavioral Health services
Identify, document, communication and coordinate care engaging collaborative care partners to facilitation transition to an appropriate level of care
Engage with medical director when additional clinical expertise if needed
Maintain knowledge of state and federal regulations, including State Contracts and Provider Agreements, benefits, and accreditation standards
Identify and refer quality issues to Quality Improvement
Identify and refer appropriate members for Care Management
Provide guidance to non-clinical staff
Provide guidance and support to LPN staff
Attend medical advisement and State Hearing meetings, as requested
Assist Team Leader with special projects or research, as requested
Perform any other job related duties as requested
Qualification
Required
Associates of Science (A.S) in Nursing required or
Bachelor of Science (B.S) in Social Work required
Three (3) years clinical experience required
Current, unrestricted Registered Nurse (RN) Licensure or Licensed Social Worker (LSW) required
MCG Certification is required or must be obtained within six (6) months of hire required
Proficient data entry skills and ability to navigate clinical platforms successfully
Working knowledge of Microsoft Outlook, Word, and Excel
Effective oral and written communication skills
Ability to work independently and within a team environment
Attention to detail
Proper grammar usage and phone etiquette
Time management and prioritization skills
Customer service oriented
Decision making/problem solving skills
Strong organizational skills
Change resiliency
Preferred
Utilization Management/Utilization Review experience preferred
Medicaid/Medicare/Commercial experience preferred
Benefits
You may qualify for a bonus tied to company and individual performance.
We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Company
CareSource
CareSource provides managed care services to Medicaid beneficiaries.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
FHLB Cincinnati
2026-01-17Grant
Leadership Team
Erhardt Preitauer
President & Chief Executive Officer
Jason Bearden
Market President and CEO, Georgia
Recent News
2026-01-18
Dayton Daily News
2025-12-17
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