Jobs at CareSource

The Behavioral Health Provider Engagement Specialist III manages provider contracting, recruitment, and engagement strategies, ensuring compliance and effective partnerships to enhance provider network performance.

Senior business analyst leading cross-functional teams to elicit and manage complex requirements, maintain Epics/Features lifecycle, align solutions to strategy, mentor analysts, drive process improvements, and present KPI-driven insights to stakeholders and executive leadership.

Primary contact and advocate for new members transitioning to a health plan. Conduct telephonic outreach, document existing and requested services, coordinate with internal and external providers, schedule nurse intake visits, educate members on plan offerings, use motivational interviewing to engage members, utilize EMR/care management and telehealth tools, and escalate unmet clinical needs as appropriate.

The Applied AI Scientist III develops advanced analytics solutions utilizing AI technologies, leading projects in predictive analytics and NLP to enhance healthcare operations and patient care.

Perform actuarial analyses and reporting to support management decisions: calculate profitability, prepare monthly IBNR reserves, evaluate reimbursement processes and assumptions, run ad-hoc studies to improve efficiency, MLR, and operating results, and contribute on cross-functional initiatives.

The Claims Management Analyst III leads eBusiness initiatives, manages EDI trading partners, ensures compliance, and analyzes performance for continuous improvement.

The Senior Manager leads DSNP bid strategy and execution, ensuring compliant submissions across states, managing risks, and coordinating cross-functional activities related to bid development.

The Senior Manager, DSNP Product Operations leads operational aspects of DSNP products, ensuring compliance, scalability, and efficiency through collaboration and performance oversight.

The Configuration Architect oversees the architecture for clinical system configurations, ensures alignment with business needs, evaluates solutions, and leads teams in implementing standards and guidelines while mentoring others in the department.