Team Lead, Clinical Care Review – Behavioral Health

CareSource

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

Posted 10/27/2026full-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 standards and effective team leadership. Proficient in analyzing healthcare service complexities and developing workload-management strategies to enhance team performance.

Highest-signal resume keywords

Utilization Management ExperienceRegistered Nurse LicenseLeadership SkillsClinical ExperienceTraining Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization ReviewDischarge PlanningTrend AnalysisQuality Standards MonitoringActivity ReportingProcess ImprovementHealthcare Service DeliveryCompliance AuditingDocumentation StandardsWorkload Management

Soft Skills

Critical ThinkingDecision MakingNegotiation SkillsAttention to DetailTime Management

Tools & Technologies

Microsoft WordMicrosoft Excel

Certifications & Qualifications

Registered Nurse (RN)Certified Care Manager

Industry Keywords

HealthcareCare ManagementNCQA GuidelinesURAC GuidelinesClinical Care Review

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 management and leadership with process-improvement activities and refining utilization and care-level processes
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 utilization review guidelines and standards, and URAC review guidelines
Provide input into CCR team evaluations and assist with team goals
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 (5) 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
Decision making/problem solving skills
Attention to detail
Time management skills
Proper grammar usage
Proper phone etiquette
Customer service orientation

Benefits

Comp & perks

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