Team Lead, Clinical Care Review
Core
Provide direct oversight of Clinical Care Review (CCR) employees, manage day-to-day workflow, and ensure cost-effective delivery of healthcare services for CareSource members.
Role type
Senior management-level clinical care review team lead
Builds
Utilization review and discharge planning activities for CareSource members
Domain
Healthcare / Utilization Management
Deliverable
client delivery
Required skills
Utilization Management/Utilization Review experience, clinical experience, supervisory skills, audit compliance, process improvement, state hearing attendance, team evaluation design
Preferred skills
Mental health professional background, Registered Nurse (RN) background, Certified Care Manager certification, multi-state licensure, MCG Certification
Technologies
Microsoft Word, Microsoft Excel
Responsibilities
Provide direct oversight of CCR employees and oversee day-to-day workflow; Ensure direct reports meet quality and productivity standards; Develop workload management plans based on trend analysis; Standardize activity and outcome reporting for department initiatives; Perform audits to ensure compliance with policies and regulatory guidelines; Act as liaison between Care Management, Claims, Enrollment, and Customer Service; Attend state hearings as necessary
Seniority
Senior, hands-on IC with management responsibilities