CareSource · 3 hours ago
Team Lead, QI Clinical Appeals - R11909
Ohio, United States
Full-time
Onsite
Mid, Senior Level
$72K/yr - $116K/yr
3+ years expCareSource is dedicated to providing quality care and compliance in healthcare services. The Team Lead, QI Clinical Appeals will oversee project management of clinical appeals and state hearings, ensuring compliance with regulatory and accreditation standards while leading a team of healthcare professionals.
Health CareMedicalNon Profit
Responsibilities
Under the direction of the Clinical Appeals Manager, lead a team of Registered Nurses, Coordinators and clerical personnel to coordinate and monitor all aspects of the clinical appeal and state hearing processes
Track and monitor all clinical appeals and state/fair hearings across all states
Ensure all activities are well coordinated, efficient and effective
Ensure staff are educated and have a thorough understanding of accreditation standards for their roles
Ensure all activities meet regulatory, contractual, accreditation requirements
In collaboration with the QI and Clinical Appeals Managers, generate, monitor and analyze reports related to key statistics and other reports deemed necessary
Oversight of the audit process for clinical appeals and state hearings to ensure compliance with regulatory and accreditation standards
Develop and implement SOPs and training tools related to all jobs
Monitor and revise the department’s orientation manual to ensure it is up-to-date with the latest processes
Coordinate project management while collaborating with clinical staff and clerical staff to ensure desirable outcomes
Problem solving to remove barriers in reaching clinical performance initiative goals
Manage staffing and scheduling functions
Maintain positive relationship with internal and external customers
Perform any other job related instructions, as requested
Qualification
Required
Bachelor's Degree or equivalent years of relevant work experience is required
Strong communication skills and ability to work with multidisciplinary departments across the organization
Proficient with Microsoft Office, including Outlook, Word and Excel
Communication skills both written or verbal
Management skills
Prior supervisory skills
Ability to work independently and within a team environment
Attention to detail
Familiarity of the healthcare field
Knowledge of Medicaid/Medicare
Proper grammar usage
Time management skills
Proper phone etiquette
Customer service oriented
Decision making/problem solving skills
Leadership experience and skills
Capable of multitasking
Preferred
Three (3) years of previous management/leadership experience is preferred
Experience with FACETS preferred
Healthcare and/or HMO experience is preferred
Benefits
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 (30)
2024 (39)
2023 (35)
2022 (21)
2021 (37)
2020 (28)
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
Company data provided by crunchbase