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Clinical Care Reviewer II - Behavioral Health

June 4, 2026

Job Summary: Clinical Care Reviewer II – Behavioral Health is responsible for processing medical necessity reviews for appropriateness of authorization for behavioral health care services, assisting with discharge planning activities (i.e. outpatient services, home health services) and care coordination for members. Essential Functions:<ul><li>Complete prospective, concurrent and retrospective review of Behavioral Health services </li> <li>Identify, document, communication and coordinate care engaging collaborative care partners to facilitation transition to an appropriate level of care</li> <li>Engage with medical director when additional clinical expertise if needed</li> <li>Maintain knowledge of state and federal regulations, including State Contracts and Provider Agreements, benefits, and accreditation standards </li> <li>Identify and refer quality issues to Quality Improvement </li> <li>Identify and refer appropriate members for Care Management </li> <li>Provide guidance to non-clinical staff </li> <li>Provide guidance and support to LPN staff </li> <li>Attend medical advisement and State Hearing meetings, as requested </li> <li>Assist Team Leader with special projects or research, as requested </li><li>Perform any other job related duties as requested.</li></ul> Education and Experience:<ul><li>Associates of Science (A.S) in Nursing required or</li> <li>Bachelor of Science (B.S) in Social Work required or</li> <li>Master's degree in a mental health related field (Psychology, Counseling Psychology, Marriage or Family Therapy) required </li><li>Three (3) years clinical experience required </li> <li> Utilization Management/Utilization Review experience preferred </li> <li> Medicaid/Medicare/Commercial experience preferred </li></ul>Competencies, Knowledge and Skills:<ul><li>Proficient data entry skills and ability to navigate clinical platforms successfully</li> <li>Working knowledge of Microsoft Outlook, Word, and Excel</li> <li>Effective oral and written communication skills</li> <li>Ability to work independently and within a team environment</li> <li>Attention to detail</li> <li>Proper grammar usage and phone etiquette</li> <li>Time management and prioritization skills</li> <li>Customer service oriented</li> <li>Decision making/problem solving skills</li> <li>Strong organizational skills</li> <li>Change resiliency</li></ul>Licensure and Certification:<ul><li> Current, unrestricted Registered Nurse (RN) Licensure, Licensed Social Worker (LSW, Licensed Clinical Social Worker (LCSW), Licensed Independent Clinical Social Worker (LICSW), Associate Clinical Social Worker (ACSW), Licensed Mental Health Counselor (LMHC), Licensed Professional Counselor (LPC), Licensed Marriage & Family Therapist (LMFT) or Licensed Mental Health Practitioner (LMHP) required </li> <li> MCG Certification is required or must be obtained within six (6) months of hire required </li> </ul>Working Conditions:<ul><li>General office environment; may be required to sit or stand for extended periods of time</li><li> Travel is not typically required</li></ul>Compensation Range:$62,700.00 - $100,400.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary):HourlyOrganization Level Competencies <ul><li style="text-align:left">Fostering a Collaborative Workplace Culture</li><li style="text-align:left">Cultivate Partnerships</li><li style="text-align:left">Develop Self and Others</li><li style="text-align:left">Drive Execution</li><li style="text-align:left">Influence Others</li><li style="text-align:left">Pursue Personal Excellence</li><li style="text-align:left">Understand the Business</li></ul> <h2>This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.</h2>#LI-JM1

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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