Jobs at CareSource

Community-based Registered Nurse responsible for complex care management of dually-eligible enrollees. Conduct in-home and community assessments, develop and implement care plans, coordinate with providers and community resources, lead interdisciplinary teams, assist with long-term supports and benefits navigation, provide education, perform post-hospital follow-up, and ensure adherence to NCQA and care management standards. Frequent travel within assigned Massachusetts territory required.

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

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.

Senior BI/reporting role focused on LTSS & Dual Eligible programs. Develop ETL pipelines, complex reports, and interactive Power BI/Tableau dashboards; perform advanced data modeling, analysis, and governance to drive operational and clinical improvements.

Serve as the subject matter expert for NCQA and other accreditations, working with business owners to identify gaps, prepare and submit materials, maintain accreditation roadmaps, track deliverables, monitor surveys, implement mitigation plans, provide training, and mentor junior staff to ensure compliance with accreditation standards.

Lead capture and proposal strategy for Medicaid procurements across the full solicitation lifecycle. Coordinate cross-functional teams, develop win themes, manage schedules, ensure compliance, produce high-quality RFP responses, and support oral presentations, BAFOs, and implementation handoffs.

Design, develop, and implement ETL/BI and metadata/cataloging solutions. Lead data governance and data quality programs, build metadata catalogs, profile and remediate data issues, collaborate with stakeholders to define business rules and metrics, and support data stewardship and governance activities.

Lead operational and compliance oversight for Utilization Management. Drive process improvements, assess data for regulatory alignment, implement changes, collaborate with clinical, analytics, and compliance teams, support parity and NQTL submissions, manage change initiatives, and recommend UM strategy and product filing actions to maintain accreditation and regulatory requirements.

Lead end-to-end claims automation and AI initiatives: manage intake, prioritize based on ROI, design and implement solutions (RPA/GenAI/LLM), drive testing, adoption, and post-production value tracking across cross-functional teams.

Senior Business Analyst leading cross-functional teams to define and manage Epics/Features, elicit complex requirements, ensure traceability, drive strategic initiatives, mentor analysts, analyze KPIs/dashboards, and coordinate stakeholder communication to deliver high-impact projects using Agile and hybrid development processes.

Manage day-to-day operations for national provider network programs: create integrated workplans, run program cadence, track milestones, manage risks/issues, synthesize executive reports, coordinate cross-functional teams, promote AI-enabled tools, and support leadership presentations to ensure timely delivery and alignment.

Lead enterprise adoption and toolchain integration for business analysis across federated teams. Design enablement curriculum, integrate standards and AI-enabled tooling (Azure DevOps, ServiceNow, Nexus, Power BI), build decision-oriented dashboards and leading indicators, drive adoption and governance, surface portfolio trends, and partner with stakeholders to improve delivery predictability and compliance.

Lead actuarial strategy and a team to deliver pricing, forecasting, rate filings, financial projections, and regulatory engagement. Develop statistical models, oversee month-end close activities, ensure actuarial compliance, mentor staff, support business development, and provide actuarial insight across the organization to inform financial and policy decisions.

Lead and manage actuarial functions including pricing, forecasting, reserves, and performance monitoring. Drive model/report/process improvements, represent actuarial expertise to regulators and executives, and align actuarial inputs with finance for monthly financial reporting and strategic decision-making.

Lead and manage actuarial functions including pricing, forecasting, reserves, and performance monitoring. Drive model/report/process improvements, support financial reporting and executive decision-making, represent actuarial expertise to regulators and stakeholders, and develop actuarial team capabilities.

Lead the actuarial function to drive pricing, forecasting, rate filings, and financial analysis. Develop statistical models, ensure regulatory compliance, mentor staff, support senior management and business development, and implement AI-enabled solutions to improve efficiency and insights.

Lead actuarial strategy and teams to deliver pricing, forecasting, rate filings, financial projections, and performance monitoring. Develop statistical and contract models, ensure regulatory compliance, mentor actuaries, support business development, and drive AI-enabled actuarial solutions to improve efficiency and decision support.

Support operations with regulatory and compliance tasks: analyze claims data, manage audit and regulatory deliverables, draft policies and job aids, train business partners, track corrective actions and regulatory reporting, and collaborate with IT and business owners to resolve data and claims issues.

Design, validate, and operationalize predictive and machine learning models; mine and analyze large datasets; create visualizations and statistical validation; collaborate with teams to integrate solutions and communicate results to stakeholders.

Lead oversight and monitoring of operations regulatory requirements, HEDIS initiatives, and SOC-1 controls. Mentor analysts, perform audits and monthly quality reviews across claims, provider appeals, enrollment and provider services. Identify risks, controls, and process gaps; drive process-improvement initiatives; track financial savings and costs; generate in-depth reports and recommendations; work cross-functionally with limited supervision.