Clinical Care Reviewer II – RN, Compact License
CareSource
Posted: 10/20/2026Clinical Care Reviewer II – Behavioral Health, Prefer MA Licensed
CareSource
Posted: 10/2/2026Clinical Care Reviewer II – Inpatient MCD, Multi State LOB
CareSource
Posted: 9/21/2026Clinical Care Reviewer II – RN, Compact License
CareSourceCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Utilization Management and clinical care coordination, with a strong focus on compliance with state and federal regulations. Proficient in data entry and navigating clinical platforms, while providing guidance to clinical and non-clinical staff.
Highest-signal resume keywords
Registered Nurse (RN) LicensureUtilization Management ExperienceMCG CertificationClinical ExperienceEffective Communication Skills
About the role
Key responsibilities & impact- Complete prospective, concurrent, and retrospective reviews for acute inpatient admissions, post-acute admissions, elective inpatient admissions, outpatient procedures, homecare services, and durable medical equipment
- Identify, document, communicate, and coordinate care with collaborative care partners to facilitate transitions to an appropriate level of care
- Engage with the medical director when additional clinical expertise is needed
- Maintain knowledge of state and federal regulations governing CareSource, State Contracts and Provider Agreements, benefits, and accreditation standards
- Identify and refer quality issues to Quality Improvement
- Identify and refer appropriate members for Care Management
- Provide guidance to non-clinical staff
- Provide guidance and support to LPN clinical staff as appropriate
- Attend medical advisement and State Hearing meetings as requested
- Assist the Team Leader with special projects or research as requested
- Perform other job-related duties as requested
Requirements
What you’ll need- RN with Compact License and MA License, or Compact License with willingness to obtain MA license
- Associates of Science (A.S) completion of an accredited registered nursing (RN) degree program required
- Three (3) years clinical experience required
- Med/surgical, emergency acute clinical care or home health experience preferred
- Utilization Management/Utilization Review experience preferred
- Medicaid/Medicare/Commercial experience preferred
- Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice required
- MCG Certification or must be obtained within six (6) months of hire required
- Proficient data entry skills and ability to navigate clinical platforms successfully
- Working knowledge of Microsoft Outlook, Word, and Excel
- Effective oral and written communication skills
- Ability to work independently and within a team environment
- Attention to detail
- Proper grammar usage and phone etiquette
- Time management and prioritization skills
- Customer service oriented
- Decision making/problem solving skills
- Strong organizational skills
- Change resiliency
Benefits
Comp & perks- Potential bonus tied to company and individual performance
- Substantial and comprehensive total rewards package
- Equal Opportunity Employer environment fostering belonging and supporting individuals of all backgrounds
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Utilization ManagementClinical Care CoordinationData Entry SkillsClinical Platform NavigationAttention to DetailTime ManagementDecision MakingProblem SolvingOrganizational SkillsMed/Surgical Experience
Soft Skills
Effective Oral CommunicationEffective Written CommunicationCustomer Service OrientationAbility to Work IndependentlyTeam Collaboration
Tools & Technologies
Microsoft OutlookMicrosoft WordMicrosoft Excel
Certifications & Qualifications
MCG CertificationCompact RN LicenseMA RN License
Industry Keywords
MedicaidMedicareCommercial InsuranceQuality ImprovementCare ManagementState ContractsProvider AgreementsAccreditation Standards