Job Summary: The Director, Claims Process Optimization leads the design, implementation, and ongoing oversight of automation and artificial intelligence capabilities across CareSource claims operations. This position is accountable for identifying where intelligent automation can remove manual effort,
Job Summary: The Product Manager owns the strategy, vision, operating model, and roadmap for assigned products, capabilities, or enterprise transformation initiatives. This role translates business, customer, regulatory, operational, and technology objectives into prioritized, phased delivery plans;
Job Summary: The Product Manager owns the strategy, vision, operating model, and roadmap for assigned products, capabilities, or enterprise transformation initiatives. This role translates business, customer, regulatory, operational, and technology objectives into prioritized, phased delivery plans;
Job Summary: The Integrated Care Clinical Manager - Massachusetts is a community based registered nurse responsible for providing monitoring, follow-up and clinical care management to dually-eligible enrollees with complex medical, behavioral and social care needs. This
Job Summary: The Operations Business Analyst IV oversees the business analysis initiatives to drive operational excellence and efficiency of existing processes and systems, leads cross functional process improvements, and aligns solutions with organizational strategy. Claims adjudication
Job Summary: The Business Analyst IV serves as a business analysis leader responsible for shaping business strategy, guiding enterprise initiatives, and driving alignment between organizational objectives and technology-enabled solutions. This role partners with leadership to define
Job Summary: The Broker Concierge Sales and Service Associate II primarily serves as a dedicated operational advocate for CareSources highest performing brokers, agencies and FMOs. Provides high-touch, personalized support by owning complex pre and post enrollment issues
Job Summary: The Manager, Finance - Cost Reporting is responsible for managing the cost reporting processes within the finance department. This role involves ensuring accuracy and completeness of financial data, preparing detailed cost reports, and analyzing
Job Summary: Medical/Clinical Policy Writer research and develop moderate to complex Medical/Clinical, BH, and Reimbursement policies; ensure adherence to company, state, and federal guidelines. Essential Functions: Support the operational processes of the Policy Governance Committee Monitor
Job Summary: Complex Population Service Determination Specialist II is responsible for processing medical necessity and noncommunity supports and service health care reviews for appropriateness of authorization to include home and community-based supports. This role assists with
Job Summary: The Pharmacy Technician II is responsible for data entry and review of submitted authorization requests, providing assistance to providers or pharmacies calling for assistance, and ensuring resolution for escalations received in the pharmacy department.
Job Summary: The Manager, Grievance and Appeals is responsible for oversight of the Grievance, Appeal, IRE/IRO and State Hearing teams within CareSource. Essential Functions: Provide leadership and direction to staff to ensure the goals and standards of
Job Summary: The Manager, Provider Performance Engagement is accountable for overseeing the performance engagement activities with internal and external partners. With a focus on improving health outcomes and total cost of care, the manager, Provider Performance
Job Summary: The Project Manager III is responsible for managing medium to high complexity projects within programs and high complexity standalone projects. Essential Functions: Responsible for successful delivery of project Ensure project milestone deliverables are completed
Job Summary: The Director, Compliance is responsible for establishing a baseline of compliance risk, identifying areas of potential exposure, developing and aligning compliance risk management strategies with CareSource goals and objectives, and executing the compliance program ensuring
Internship Program The CareSource Intern is responsible for providing support on special projects, initiatives, and specific activities which will vary by assignment. We offer a 12-week, paid summer internship program for college students who want to separate
Job Summary: The Digital Product Manager I is responsible for managing digital product(s) from the planning phase through deliverables coordination, execution, communication, and results tracking. Essential Functions: Manage growth and optimization of digital products aimed at
Job Summary: The Clinical Care Manager-Massachusetts is a community based registered nurse responsible for providing monitoring, follow-up and clinical care management to dually-eligible enrollees with complex medical, behavioral and social care needs. This position focuses on
Job Summary: Vice President, Market Operations - Ohio is responsible for developing the overall market program strategy and business objectives; lead the alignment and collaboration to establish CareSource as the industry leader in member and provider engagement,
Job Description: Develop the strategic vision for and manage IT products and projects. Work closely with the Scrum team to maintain focus on goals, alignment with business needs and urgent matters, and adherence to strategic vision,