Team Lead, Clinical Care Review

CareSource

. Provide direct oversight of Clinical Care Review employees and oversee day-to-day workflow within the CCR team .

Posted 9/23/2026full-timeRemote • United StatesSenior💰 $72,200 - $115,500 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Utilization Management and Review, with a strong focus on compliance with regulatory requirements and quality standards in healthcare delivery. Proven ability to lead and develop teams while implementing process improvements and managing workload effectively.

Highest-signal resume keywords

Utilization Management ExperienceRegistered Nurse LicenseClinical ExperienceLeadership SkillsProcess Improvement

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization ReviewDischarge PlanningTrend AnalysisActivity ReportingCost-Effective Healthcare DeliveryCompliance AuditingWorkload ManagementTraining SkillsNegotiation SkillsBasic Computer Skills

Soft Skills

Critical ListeningCritical ThinkingTeam CollaborationIndependent WorkSupervisory Skills

Tools & Technologies

Microsoft WordMicrosoft Excel

Certifications & Qualifications

Registered Nurse (RN) LicenseCertified Care ManagerMCG CertificationCompact RN LicenseMulti-State Counselor/Social Worker Licensure

Industry Keywords

Healthcare FieldNCQA GuidelinesURAC GuidelinesCare ManagementQuality Standards

About the role

Key responsibilities & impact

Provide direct oversight of Clinical Care Review employees and oversee day-to-day workflow within the CCR team
Ensure direct reports meet minimum quality and productivity standards
Analyze health condition and service complexities
Develop workload management plans based on trend analysis and advocate for the CCR team
Provide feedback, guidance, orientation, training, and ongoing resources to CCRs and the pre-authorization team
Standardize activity and outcome reporting for department initiatives and programs, including documentation required by the State and accrediting bodies
Perform utilization review and discharge planning activities for CareSource members
Monitor appropriate, cost-effective delivery of healthcare services
Assist with process improvement activities and refine processes supporting cost-effective utilization and appropriate levels of care
Liaise with Care Management, Claims, Enrollment, Customer Service, and other areas to resolve problems
Audit CCR team members for compliance with CareSource policies, processes, regulatory requirements, NCQA guidelines, and URAC guidelines
Provide input into team evaluations and assist with team goal development
Design and present utilization management informational meetings
Attend state hearings as necessary
Perform other requested job duties

Requirements

What you’ll need

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
Current, unrestricted license as a Registered Nurse (RN) or a mental health professional (e.g., LPC, LCSW) is required
Minimum of five years clinical experience preferred
Certified Care Manager experience preferred
Basic computer skills
Basic proficiency in Microsoft Word and Excel
Management skills
Prior supervisory skills
Ability to work independently and within a team environment
Familiarity with the healthcare field
Critical listening and thinking skills
Training/teaching skills
Negotiation skills/experience
Leadership experience and skills
Compact RN license or Multi-state Counselor/Social Worker licensure preferred
MCG Certification preferred

Benefits

Comp & perks

Bonus tied to company and individual performance may be available
Substantial and comprehensive total rewards package
Employee total well-being support