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 Participate in peer-to-peer
Job Summary: The Utilization Management (UM) Market Operations Manager is responsible for the operational activities of UM and Appeals for a specified line(s) of business managing the development of policies and procedures, review of team metrics,
Job Summary: The Enterprise Quality Statistician leads, implements, and conducts analysis for quality and performance improvement and population health processes through the integration of quality improvement science and advanced statistical methodologies. Essential Functions: Serve as the
Job Summary: The Market Development Partner (MDP) is responsible for cultivating and managing strategic relationships with key market stakeholders, including healthcare providers, community-based organizations, LTSS entities, and advocacy groups, driving growth by self-generating leads and supporting
Job Summary: The Care Delivery Triage RN is responsible for performing telephonic clinical triage and providing health information service and care coordination as a key part of the primary care team, and acts as the primary
Job Summary: The Medical Director, Neonatology is responsible for providing subject matter expertise and medical leadership in the development of utilization management, care management and quality of care programs for infant and neonatology services. Essential Functions:
Job Summary: The Market Development Partner (MDP) is responsible for cultivating and managing strategic relationships with key market stakeholders, including healthcare providers, community-based organizations, LTSS entities, and advocacy groups, driving growth by self-generating leads and supporting
Job Summary: The Director, Health Partner Engagement directs, oversees, and manages strong relationships with key Health Partners throughout the state to ensure CareSource delivers and meets the specifications of our Health Partner contractors. Essential Functions: Identifies and
Job Summary: The Director, Network Performance & Engagement provides expert leadership, analysis and ongoing support in the areas of provider network operations including Total Cost of Care (TCOC), value-based purchasing, and state or federal quality initiatives,
Job Summary: The Program Manager, Market Vendor Performance is responsible for coordinating programs that support the delivery of member benefits including durable medical equipment (DME), home modification, and wheelchair repair services. This role partners with internal
Job Summary: The Medical Records Coordinator II is responsible for all forms and aspects of retrospective medical record retrieval including, but not limited to, claims data analysis, outreach data research, direct EMR retrieval, Requests of Information
Job Summary: The Integrated Care Program Manager is responsible for managing large-scale portfolio programs aligned to strategic objectives that include multiple projects. Essential Functions: Responsible for successful delivery of LTSS and Dual Eligible programs Understand the
Job Summary: The Market Administrative Assistant III is responsible for assisting with special projects, conduct research, compile data and maintain records. This is a hybrid position, working 2+ days a week in the Rainbow Sunset Pavillion
Manager, Information Technology – Encounters IT (Transformation & Architecture Focus) Job Summary The Manager, Information Technology – Encounters IT is a technology leader and visionary responsible for driving modernization, scalability, and innovation across the Encounter Management
Job Summary: The Data Scientist III is responsible for designing and validating predictive models, machine learning models, and artificial intelligence that inform and improve business processes across the organization (operational, clinical, financial, marketing, etc.). Essential Functions:
Job Summary: The Senior Director, Supplemental Providers & Enhanced Benefits is responsible for the oversight, administration, and performance of supplemental vendor relationships and enhanced benefit programs across assigned markets and products. This position is responsible for
Job Summary: The Customer Care Specialist I assists members/beneficiaries or providers with routine service inquiries. Essential Functions: Resolve member/beneficiaries or provider routine service inquiries; examples include claims processing, member benefit education, contracting and credentialing requests, and
Job Summary: The Service Process Analyst II identifies opportunities for improvement in Customer Cares business processes and recommends projects aimed at enhancing quality, reducing costs, and promoting automation and call reduction. This position collaborates with stakeholders
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
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