Search the 32 jobs at CareSource

The Senior Manager, Provider Contracting Analytics oversees daily operations in provider contracting analytics, focusing on analysis and modeling for health partner contracts, and collaborating with other departments. Responsibilities include identifying contracting improvements, developing action plans, reporting results, adhering to regulations, and mentoring analysts.

The Senior Manager, Payment Integrity leads the department to achieve goals related to medical auditing, overseeing coding auditors, optimizing processes, and implementing new projects while ensuring compliance with regulations. Responsibilities include managing coding guidelines, analyzing reimbursement processes, developing procedures, and providing staff oversight.

The Data Solutions Engineer III is responsible for the full life cycle of data and analytic solutions, focusing on Power BI development. Duties include designing complex reports, optimizing data models, partnering in product ideation, mentoring colleagues, and ensuring data security while maintaining advanced levels of data analysis and business intelligence.

The Data Science and AI Manager will lead the development of advanced analytics solutions utilizing NLP and AI to enhance healthcare operations and patient care. This role includes mentoring a team, delivering complex data science projects, and collaborating with various departments to drive data-driven solutions. Responsibilities also involve predictive modeling, data analysis, and ensuring compliance with data regulations.

The Contract System Analyst I provides technical support and manages databases for provider contracting. They ensure data integrity, assist in database setup, and collaborate with IT and analytics teams. Duties include monitoring performance, assisting with data transitions, conducting audits, and providing training to team members.

The Actuarial Analyst III analyzes data and provides strategic recommendations to management. This role involves calculating profitability reports, leading actuarial processes, mentoring analysts, and participating in cross-functional teams to improve operational results.

The Compliance Analyst II is responsible for supporting the effectiveness of the Compliance Program by analyzing compliance requirements, supporting departments with implementation, conducting audits, and providing training. This role involves relationship management with stakeholders, investigating compliance risks, and ensuring thorough documentation of corrective actions.

The Community Marketing Representative II focuses on supporting sales enrollment strategies by promoting CareSource products through community education sessions. Responsibilities include conducting presentations, collaborating on marketing strategies, managing budgets, and driving membership acquisition while adhering to state and federal regulations.

The AVP of Market Operations assists the Market President in market operations by providing strategic compliance and financial guidance, ensuring adherence to regulatory requirements, and overseeing contract management. Responsibilities include advising on business initiatives, managing compliance risks, and maintaining relationships with regulators, alongside supporting financial analysis and operational efficiency efforts.

The Manager of Provider Network Performance will lead a team to implement and enhance Value Based Reimbursement (VBR) initiatives, develop action plans, track project performance, and manage process improvement opportunities. This role involves strategic collaboration with various business units, analysis of provider networks, and the development of comprehensive reporting and performance models.

The Community Marketing Representative III develops strategies for building productive relationships with community partners to enhance enrollment for Medicaid, Marketplace, MyCare, and Medicare Advantage. This role involves collaborating with regional agencies, supporting sales strategies, creating marketing opportunities, coordinating community events, and educating stakeholders about CareSource's offerings while maintaining active communication and compliance with state regulations.

The Paralegal II supports the Office of the General Counsel in areas such as Litigation, Employment, Privacy, and Real Estate. Responsibilities include reviewing and preparing legal documents, conducting research, responding to inquiries, maintaining confidentiality, and managing administrative tasks as assigned by senior attorneys.

The Managing Actuary provides leadership and direction to ensure team goals and strategies are successfully achieved. Responsibilities include pricing, forecasting, reserving, developing key assumptions, managing actuarial models, and communicating strategic recommendations to leadership.

The Technical Lead, EDI will oversee the technical delivery and management of EDI systems, improve platform resilience, prioritize team activities, and ensure high-quality software development. They will collaborate with cross-functional teams, enforce standards, and provide guidance on technical solutions while managing project lifecycles and addressing technical risks.

The Provider Relations Account Manager is tasked with managing provider relationships, ensuring operational efficiencies, and enhancing provider satisfaction. Responsibilities include leading meetings, analyzing processes for improvement, performing quality assurance reviews, and supporting leadership goals through effective data management and project oversight.

The Community Marketing Representative II will support sales enrollment strategies and collaborate with management to achieve membership goals. Responsibilities include conducting educational sessions, community outreach, marketing strategies, and relationship management with key agencies to drive new membership acquisition and retention.

The Actuarial Analyst I role involves providing data analysis and recommendations to management, performing profitability calculations, and evaluating operational efficiencies. The analyst participates in cross-functional teams, prepares financial reserves calculations, and analyzes the government reimbursement process.

Community Marketing Representative II responsible for supporting sales enrollment strategy, conducting sales presentations, collaborating with various departments, delivering educational presentations, and adhering to marketing regulations.

Community Marketing Representative II responsible for supporting sales enrollment strategy and achieving membership goals through sales presentations, educational sessions, and outreach programs to specified industries and community organizations. Collaborates cross-functionally to enhance engagement strategies and adhere to marketing regulations. Manages budget, relationship with key agencies, and coordinates activities to drive new membership acquisition and retention. Regular travel required for member, provider, and community visits.

As the AVP of Actuarial Science, you will drive company strategy, manage actuarial expertise, oversee actuarial functions, support finance alignment, and implement best practices for reporting, requiring extensive experience in the actuarial field, particularly in healthcare and regulation interaction.