Remote Case Management: Clinical Services Utilization Supervisor

CareStar, Inc.; Cincinnati (OH); Hybrid; USD 55,000 - 75,000; Full time

Benefits offered by this job

Remote flexibility

Competitive salary

Medical insurance

Dental insurance

Vision insurance

Life insurance

401(k) with match

Paid time off

ESOP

Job summary

CareStar, Inc. in Ohio is seeking a Clinical Services Utilization Supervisor to oversee Hamilton County and surrounding areas. You will assess needs, develop care plans, and coordinate services with Medicaid and state programs.

This remote with field visits role offers flexibility, competitive salary based on experience, and comprehensive benefits. You will lead clinical staff, ensure compliance with guidelines, and represent CareStar at hearings and in appeals.

Qualifications

• Bachelor’s degree in Social Work, Counseling, Psychology, Nursing, or related field
• LSW, LISW, or RN licensure
• Minimum 3 years of home and community-based services experience within the last 10 years
• Experience with individuals with chronic conditions or severe mental illness
• Strong knowledge of Medicaid, behavioral health systems, and local resources

Responsibilities

• Monitor service delivery and ensure compliance with program guidelines
• Serve as the lead advocate and care coordinator for each participant
• Educate and counsel clinical staff on due process and prior authorizations
• Prepare training materials and conduct staff training on due process and prior authorizations
• Assist staff with disenrollment determinations and referrals to Clinical Supervisor/Manager
• Maintain knowledge of Medicare, Medicaid, and state waivers and ADA
• Assist with state program information to support business objectives
• Prepare appeal summaries and represent CareStar at hearings

Skills

Medicaid knowledge

Behavioral health systems

Community resources

Education

Bachelor's degree in related field

Job description

CareStar, Inc. in Ohio is seeking a Clinical Services Utilization Supervisor to oversee Hamilton County and surrounding areas. You will assess needs, develop care plans, and coordinate services with Medicaid and state programs.

This remote with field visits role offers flexibility, competitive salary based on experience, and comprehensive benefits. You will lead clinical staff, ensure compliance with guidelines, and represent CareStar at hearings and in appeals.