Job Summary: The Manager, Market Contracting is responsible for assisting the Director, and managing a team, to manage and negotiate assigned contracts including analysis of the contract proposals and conducting financial impact to make informed decisions
Job Summary: The Provider Contracting Analyst II supports the development, validation, and optimization of provider reimbursement strategies through advanced data analysis, financial modeling, and AI-enabled analytic tools. This role is responsible for evaluating provider payment methodologies,
Job Summary: The Clinical Appeals Medical Director will perform medical necessity review of appeals, within the organization, ensuring timely, accurate, quality and compliant review of clinical appeals. Administers the decision-making process related to appeals, supports clinical
Job Summary: Senior Manager, Capacity Planning & Reporting is responsible for developing a staffing strategy to optimize staffing and digital resources to meet all regulatory and quality requirements. This role will work to develop strategies to
Job Summary: The Manager, Field Sales is responsible for leading and overseeing a team of sales representatives operating in the field to achieve enrollment targets and drive business growth. The Manager will analyze market trends, monitor
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 Market Behavioral Health Medical Director is responsible for the overall safety of patients with a Behavioral Health diagnosis, with a special focus on safe prescribing. Essential Functions: Assume responsibility for the overall safety
Job Summary: Vice President, Actuarial - Product is responsible for driving company strategy and managing actuarial expertise in coordination with other leaders on all aspects of CareSource’s rate levels to ensure actuarial soundness, and to use actuarial
Job Summary: The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services to meet the members health needs while promoting quality cost effective outcomes.
Job Summary: The Clinical Care Manager-Massachusetts at CareSource/Commonwealth Care Alliance (CCA) 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.
Job Summary: Provides operational support and day-to-day coordination of rehabilitation services to ensure effective, compliant, and high-quality care delivery. Executes established program standards, supports utilization and clinical processes, and partners with internal teams and external providers
Job Summary: The Senior Director, Clinical Data Governance & Integration is responsible for developing, executing and coordinating enterprise clinical data governance and integration activities. This role ensures standardized business requirements, oversees governance cadence, and drives cross-functional
Job Summary: The Managing Actuary provides leadership and direction to ensure team goals and strategies are successfully achieved. Essential Functions: Responsible for pricing, forecasting, reserving or other actuarial processes including development of key assumptions, as well
Job Summary: The Operations Specialist II provides analytical support and leadership for project impacting Claims and key internal Claims projects. Essential Functions: Represent claims on cross-functional project work teams Submit, monitor and prioritize IT tickets for
Job Summary: The Manager, Speech Analytics and Insights collaborates with the Service Excellence team to continuously improve the experience for our customers (Member & Provider), driving innovation and efficiencies within the call center. They will play
Job Summary: The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services to meet the members health needs while promoting quality cost effective outcomes.
Job Summary: The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services to meet the members health needs while promoting quality cost effective outcomes.
Job Summary: The Clinical Care Manager-Massachusetts at CareSource/Commonwealth Care Alliance (CCA) 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.
Job Summary: The Care Delivery Advanced Practice Clinician (APC) provides comprehensive primary care and clinical care coordination to a panel of patients, including individuals with significant medical, behavioral, and social complexities that require intensive care coordination
Job Summary: The Behavioral Health Medical Director is responsible for the overall safety of patients with a BH diagnosis, with a special focus on safe prescribing. Essential Functions: Assume responsibility for the overall safety of patients