Team Lead, Clinical Care Review

CareSource•Indianapolis, IN

17d

About The Position

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. The CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers. We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day. The challenge is, there is no one right way to be the difference and we’re looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.

Requirements

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
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
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.

Nice To Haves

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

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