Job Description
Job Summary:
The Team Lead, Clinical Care Review is responsible for providing direct oversight of Clinical Care Review (CCR) employees and overseeing day-to-day workflow within the CCR team.
Essential Functions:
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
Education and Experience:
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
Minimum of five (5) years clinical experience preferred
Certified Care Manager experience is preferred
Competencies, Knowledge and Skills:
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
Licensure and Certification:
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. This listing may not include all acceptable licenses; please refer to your state licensing board for complete information on licensure requirements for your state or practice.
Compact RN license or Multi-state Counselor/Social Worker licensure is preferred
MCG Certification preferred
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$70,800.00 - $113,200.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, 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.
Compensation Type:
Salary
Competencies:
- Create an Inclusive Environment
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
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CareSource is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity, genetic information, protected veteran status or any other characteristic protected by applicable federal, state or local law.
