Clinical Services Utilization Supervisor - Ohio

Ready to join a growing company whose work profoundly impacts people's lives in their community, who offers an excellent learning environment, with opportunities to advance and the ability to work alongside talented business leaders/professionals?  CareStar, Inc. is currently seeking a Clinical Services Utilization Supervisor  to identify, coordinate and oversee the delivery of services to enhance the health, safety and general well-being of participants' goals toward maximum independence.

THE POSITION
CareStar is looking for a motivated individual with:

• Current and active license as a Licensed Social Worker, Licensed Independent Social Worker or Registered Nurse; at least three (3) years of experience in a home and community based service environment within the last ten (10) years, and at least three (3) years of either pediatric, Mental Retardation Development Disabilities or mental health experience within the last ten (10) years is desirable. 
• 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. 
• Enters information accurately into CareStar and/or state computer applications as required to perform job duties; participates in quality improvement activities, such as chart audits and project team. 
• Knowledge of Medicare, Medicaid, insurance and waiver programs; knowledge of community resources; computer skills sufficient to enter and process individual information and report preparation.  
• Ability to instruct, counsel and evaluate subordinate professional staff. 
• Understands and complies with CareStar Policies and Procedures.
• Maintains confidentiality as related to patient information.
• Follows the Acceptable Use Policy while using any information systems owned or controlled by CareStar, Inc.

THE LOCATION
This position is open in Ohio. 

THE COMPANY
CareStar was founded in 1988 in Cincinnati, Ohio with the mission to Improve Communities by Improving Lives.  We continue to be an industry leader in the field of Long-Term Care Case Management, Assessment, Population Health Management and Innovative Software Development Solutions.

WHY YOU SHOULD APPLY

• Remote working opportunities.
• Shared ownership benefit through the CareStar Employee Stock Ownership Plan (ESOP).
• Competitive salary based upon experience, education and knowledge.
• Comprehensive benefits package with medical, dental, vision, and life-insurance.
• 401(k) with a generous Safe Harbor company matching contribution.
• Paid vacations and 10 holidays per year.