Clinical Services Utilization Supervisor
Location
United States
Posted
11 days ago
Salary
Not specified
No structured requirement data.
Job Description
Clinical Services Utilization Supervisor – Hamilton & Surrounding Counties
Company: CareStar, Inc.
Location: Hamilton, Ohio (and surrounding areas)
Job Type: Full Time | Remote with Field Visits
Industry: Healthcare / Social Services / Case Management
About the Opportunity at CareStar
Founded in 1988 in Cincinnati, Ohio, CareStar, Inc. is a recognized leader in long-term care case management and population health. With a mission to Improve Communities by Improving Lives, we proudly serve individuals across Ohio through compassionate, high-quality care coordination. We are currently seeking a Clinical Services Utilization Supervisor to join our Assessments program. This is a meaningful opportunity for professionals who are passionate about helping others live healthier, more independent lives. As a Clinical Services Utilization Supervisor, you’ll work directly with individuals to assess their needs, develop personalized care plans, and connect them with essential services and supports. You’ll be part of a mission-driven team that values your expertise, supports your growth, and empowers you to make a real difference in your community.
Key Responsibilities
Monitor service delivery and ensure compliance with program guidelines
Serve as the lead advocate and care coordinator for each participant
Educates, guides, oversees, and counsel’s clinical employees in the performance of task related to Due Process and Prior Authorizations.
Formulates training material for Due Process and Prior Authorizations and conducts training for Clinical Team as necessary.
Provides guidance to staff related to applicable rule reference and disenrollment determinations; identifies problematic cases and refers to the Clinical Supervisor and/or Clinical Manager as appropriate.
Maintains/updates knowledge of Medicare, Medicaid, insurance and program and State specific waivers; maintains knowledge of the Americans with Disabilities Act.
Understands current and future state and other program information to assist with business objectives; establishes rapport with State and other programs employees.
Prepares appeal summaries and exhibits list for processing to be presented at hearing; represents CareStar at appeal hearings; be available to provide testimony at appeal hearings.
Reviews hearing rights for appropriateness and submits them for processing to ensure compliance with the State administrative code.
Reviews hearing decisions and coordinates compliance with the determination, prepares and submits compliance forms per requirements, including issuance of hearing rights.
Provides support to staff in assessing need for prior authorization and assures that determination is supported by medical necessity; reviews prior authorizations prior to submissions to state specific Department of Medicaid for completeness and compliance with the state specific administrative code and CareStar requirements.
Adhere to the CareStar Rule in performance of job responsibilities.
Understand and comply with CareStar Policies and Procedures.
Maintain confidentiality as related to patient information. Any disclosures of confidential information made unlawfully outside the proper course of duty will be treated as a serious disciplinary offense.
Follow the Acceptable Use Policy while using any information systems owned or controlled by CareStar, Inc.
Minimum Qualifications
Bachelor’s degree in Social Work, Counseling, Psychology, Nursing, or a related field and at least three (3) years of either pediatric, Developmental Disabilities or mental health experience within the last ten (10) years is desirable.
Licensed Social Worker (LSW), Licensed Independent Social Worker (LISW) or Registered Nurse (RN)
Minimum 3 year of experience in home and community-based services (within the last 10 years)
Experience working with individuals with chronic conditions or severe and persistent mental illness
Strong knowledge of Medicaid, behavioral health systems, and local community resources
Why Join CareStar?
Remote flexibility with meaningful community engagement
Competitive salary based on experience and education
Comprehensive benefits: Medical, dental, vision, life insurance
401(k) with a generous company match
Paid time off + 10 paid holidays
Employee Stock Ownership Plan (ESOP) – become a part-owner in the company
Supportive, mission-driven culture focused on improving lives
Apply Today
Ready to make a difference? Visit https://www.carestar.com/about-carestar/careers/ to apply and learn more about joining our team.
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