CareSource Jobs in United States

AI Program Manager

2 weeks ago

Job Summary: · The AI Program Manager is responsible for driving coordination, tracking, and governance of all AI initiatives across the enterprise. This role ensures timely delivery, stakeholder alignment, and measurable outcomes for CareSource's AI strategy and roadmap. This ro ...

Grievance & Appeals Specialist II (NSA Experience Preferred)

2 weeks ago

Job Summary: · The Grievance & Appeals Specialist II reviews appeals submitted by Medicaid and Medicare providers and all future providers contracted with CareSource. In regards to the No Surprise Act. (NSA Experience Preferred) · . · Essential Functions: · Prepare the appeals fo ...

Care Guide

2 weeks ago

Job Summary: · The Care Guides are responsible for participating as a member of the inter-disciplinary Care Coordination Team to coordinate care for members, meeting their individual needs and the needs of the population.  The Care Guide serves as a single point of contact for ca ...

Health Plan Operations Analyst III

2 days ago

Job Summary: · The Health Plan Operations Analyst III reviews and analyzes the effectiveness and efficiency of existing market operation processes and systems and participates in development of solutions to improve or further leverage these functions. · Essential Functions: · Man ...

Manager, MDP Analytical Engineering

4 days ago

Job Summary: · The Manager, MDP Analytical Engineering is accountable for designing, developing, and optimizing data solutions using Databricks SQL and the business intelligence platforms to generate regulatory reporting and extracts for the organization. This role focuses on tra ...

Health Partner Network Manager

2 days ago

Job Summary: · The Provider Contract Manager supports the Director, Provider Contracting & Strategic Growth with the development, implementation, and management of provider contracting operations processes. · Essential Functions: · Ensure operational effectiveness by assisting in ...

Clinical Care Reviewer II

2 days ago

Job Summary: · Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services, assisting with discharge planning activities (i.e. DME, home health services) and care coordination for members enrolled ...

Health Partner Network Manager

9 hours ago

Job Title: Health Partner Network ManagerJob Summary: · The Health Partner Network Manager executes the Health Partner contracting strategy, develops contract provisions based on cost, quality/analysis and monitors key metrics for the assigned Market. · Key Responsibilities: · Cr ...

Application Architect II

3 days ago

Job Summary: · Responsible for defining, overseeing, coordinating and developing technology designs, along with related roadmaps and lifecycle management. · Essential Functions: · Aligns efforts across various technical architectural disciplines within the company to develop inno ...

Actuarial Analyst I

3 weeks ago

Job Summary: · The Actuarial Analyst I is responsible for providing timely, accurate, and actionable data and analysis supporting the department, area, and corporate key initiatives. · Essential Functions: · Develops actionable recommendations to management relative to all analys ...

RN Community Based Care Manager

4 days ago

Job Summary: · The Community Based Care Manager collaborates with members of an inter-disciplinary care team, providers, community and faith-based organizations to improve quality and meet the needs of the individual, natural supports and the population through culturally compete ...

Health Partner Network Manager

4 days ago

Job Summary: · The Health Partner Network Manager executes the Health Partner contracting strategy, develops contract provisions based on cost, quality/analysis and monitors key metrics for the assigned Market. · Essential Functions: · Create, execute and administer value based r ...

Configuration Architect

4 days ago

Job Summary: · A Configuration Architect is responsible for defining, overseeing, and developing designs and processes to provide custom configuration solutions. · This position requires experience with Networx and drives solutions for implementation. · Key Responsibilities:Work ...

Provider Systems Analyst II

3 days ago

Job Summary: · The Systems Analyst II is responsible for collaborating with internal and external customers to elicit their business concerns and develop workable solutions. · Essential Functions: · Leverage appropriate approaches and modeling techniques to elicit requirements · ...

RN Community Based Care Manager

3 days ago

Job Summary: The Community Based Care Manager collaborates with members of an inter-disciplinary care team (ICT), providers, community and faith-based organizations to improve quality and meet the needs of the individual, natural supports and the population through culturally com ...

Medical Director

2 weeks ago

Job Summary: · The Medical Director is responsible for supporting staff by providing training, clinical consultation, and clinical case review for members. · Essential Functions: · Provide prior authorization medical reviews, consultation and clinical review services · Participat ...

Sales Operations Quality Analyst III

2 weeks ago

Job Summary: · Sales Operations Quality Analyst III is responsible for monitoring agent onboarding activities and ensure they align with communicated policies and procedures and comply with federal and state regulations. · Essential Functions: · Plan and execute specific action p ...

Senior Director, Medical Economics

4 days ago

Job Summary: · The Senior Director, Medical Economics is responsible for operating with exceptional professionalism and communication to clearly articulate performance results, medical expense trend impacts, and quantified opportunities for improved health plan performance throug ...

Team Lead, Health Partner Life Cycle

1 week ago

Job Summary: · The role of the Team Lead, Health Partner Life Cycle (HPLC) is to perform supervision and support of the Health Partner Life Cycle team.. · Essential Functions: · Responsible for accurate and timely processing of provider additions, terminations, and changes to mee ...

Community Marketing Representative II

2 days ago

Job Summary: · The Community Marketing Representative II is responsible to support the enrollment and retention strategy in collaboration with management to ensure all membership goals are successfully achieved. · Essential Functions: · Utilize an educational approach to communit ...