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
Job Summary: The Program Integrity Medical Coding Reviewer III supports most complex medical record audit programs, dispute management, escalation management and generates concise in-depth reporting and analysis to track performance related to the Pre-Pay and Post-Paid Processes.
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 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 Team Lead, Program Integrity drives and encourages innovative investigative processes and workflows to reduce turnaround time and produce positive investigative outcomes. Essential Functions: Direct the day-to-day activities and leadership of investigative staff to
Job Summary: The Operations Regulatory Specialist II provides analytical support and leadership for key internal Operations projects and partners with the Operations departments to ensure all regulatory and compliance deliverables are met. This position will work
Develop department-wide, scalable, efficient database solutions for supporting reporting functionality. Create ETL solutions for automated, scheduled data refreshes and regular report delivery. Develop and deploy Power BI dashboards which provide leadership with actionable insights that drive
Analyze, design, code and test software through the production lifecycle according to functional/technical specifications that meet business requirements. Run and monitor software performance tests on new and existing software for the purposes of correcting errors, isolating