Job Summary: The Director, Pharmacy Clinical Strategy leads the strategic development of formulary management best practices & industry-leading, market-competitive formulary and medical drug strategies across all CareSource lines of business and markets. Essential Functions: Ensures the efficient
Job Summary: The Enterprise Medical Director is responsible for the development, implementation and revision of corporate level clinical care standards and practice guidelines, ensuring compliance with nationally accepted quality standards. Essential Functions: Development, implementation and revision
Senior Field Representative, Support CIP Position Profile This position requires the solution technology level skills to work independently as a product/services solutions specialist in servicing and/or training on certain business support work area needs/offerings. Also include new
Join 2J Supply, proudly part of Rheem, a global leader in Heating, Ventilation and Air Conditioning (HVAC) innovation! With over 60 years of trusted service, 2J Supply has built a strong network across Ohio, Kentucky, West
Overview Versiti is a fusion of donors, scientific curiosity, and precision medicine that recognize the gifts of blood and life are precious. We are home to the world-renowned Blood Research Institute, we enable life saving gifts
Job Summary: The Quality Risk Adjustment Advisor IV is responsible for leading key components of the Quality Risk Adjustment (QRA) programs, including prospective programs, chart retrieval and coding processes, while ensuring compliance with regulatory standards and optimizing quality
Job Summary: The Business Analyst IV is a senior-level position responsible for driving strategic initiatives and leading cross-functional teams to deliver innovative solutions that address complex business challenges. This role bridges the gap between business needs
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: The Communications & Content Governance Specialist III is responsible for creating and managing core CareSource messaging, narratives and content that complies with company policies, brand standards, and applicable regulatory requirements. Essential Functions: Develop and
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 ecosystem.
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
Job Summary: The Program Integrity Medical Coding Reviewer II is responsible for review of medical record audit activities, dispute support as needed, medical records work queues as well as claim reviews for provider pre-payment and post-payment functions.
Job Summary: Responsible for providing direction and planning to implement and maintain information security controls, coordinate the evaluation, deployment and management of current and future security technologies, and communicating operating effectiveness to leadership. Essential Functions: Develop and
As a Senior Software Engineer, you will work as part of a tightly knit team to design, develop, implement, integrate, test, and demonstrate advanced algorithms and software systems for autonomous platforms. You will provide technical leadership
Job Summary: The Scrum Master II is responsible for guiding and coaching the Scrum Team and organization on how to use Agile/Scrum practices and values. Essential Functions: Guide and coach the Scrum Team and organization on