Team Lead - Clinical Care Review - Behavioral Health - RN - MSL

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 teamEnsure all direct reports are performing at minimum quality and productivity standards or betterUnderstand complexities of health conditions and servicesDevelop plan for management of workload after analyzing trends and act as advocate for CCR teamProvide feedback, guidance, orientation, training and ongoing resources to CCRs and pre-authorization teamStandardize activity and outcome reporting for department initiatives and programs including documentation required by the State and accrediting bodiesResponsible for utilization review and discharge planning activities for CareSource membersMonitor and ensure appropriate delivery of healthcare services in cost-effective mannerAssist manager and director in development of process improvement activities and refining of processes that facilitate cost-effective utilization and appropriate levels of careAct as a liaison between Care Management, Claims, Enrollment, Customer Service and other areas as needed to assist in problem resolutionsPerform audits of CCR team members to ensure compliance with CareSource policies, processes, regulatory requirements, NCQA utilization review guidelines and standards, and URAC review guidelinesProvide input into CCR team evaluations and assist with development of team goalsDesign and present UM informational meetings as neededResponsible for attending state hearings as necessaryPerform any other job duties as requestedEducation 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 requiredOne year of Utilization Management/Utilization Review experience requiredMinimum of five (5) years clinical experience preferredCertified Care Manager experience is preferredCompetencies, Knowledge and Skills:Basic computer skillsBasic proficiency in Microsoft Word and ExcelCommunication skillsManagement skillsPrior supervisory skillsAbility to work independently and within a team environmentAttention to detailFamiliarity of the healthcare fieldCritical listening and thinking skillsTraining/teaching skillsNegotiation skills/experienceProper grammar usageTime management skillsProper phone etiquetteCustomer service orientedDecision making/problem solving skillsLeadership experience and skillsLicensure 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 preferredMCG Certification preferredWorking Conditions:General office environment; may be required to sit or stand for extended periods of timeCompensation Range:$72,200.00 - $115,500.00CareSource 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 (hourly/salary):SalaryOrganization Level CompetenciesFostering a Collaborative Workplace CultureCultivate PartnershipsDevelop Self and OthersDrive ExecutionInfluence OthersPursue Personal ExcellenceUnderstand 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 environment of belonging that welcomes and supports individuals of all backgrounds.#LI-JM1

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