Jobs at CareSource

The Revenue Cycle Coordinator III ensures timely resolution of member complaints related to eligibility and billing, leads teams, and develops training for compliance with regulatory standards.

Manage and retain provider relationships by proactively engaging providers and internal stakeholders, conducting onboarding and training, improving compliance (EVV), supporting contracting and claims issues, producing reports, and driving provider education on billing, regulations, and system use to support quality and operational goals.

Serve as primary telephonic contact and advocate for new health plan members, document current and requested services, schedule nurse intake visits, liaise with internal and external providers to ensure continuity of care, use motivational interviewing and EMR/care management tools, and educate members on plan offerings while addressing questions and concerns.

The Configuration Architect oversees the architecture for clinical system configurations, ensures alignment with business needs, evaluates solutions, and leads teams in implementing standards and guidelines while mentoring others in the department.

The Provider Engagement Specialist oversees performance of delegated partnerships, manages data reports, collaborates with providers to enhance performance, and ensures regulatory compliance.

Provide high-level administrative support to an executive and department: prepare presentations and reports, schedule meetings, coordinate travel and expenses, handle correspondence, record minutes, maintain records, assist with research and special projects, and perform other clerical duties while maintaining confidentiality and professionalism.

Analyze healthcare claims and develop provider reimbursement models using SQL, Python, BI tools, and AI-enabled automation. Perform contract repricing, benchmarking, scenario modeling, and anomaly detection to support contracting, finance, and operations. Collaborate with actuarial, data engineering, clinical, and configuration teams to validate data, implement reimbursement logic, and deliver actionable insights for cost containment and rate development.

The Applied AI Scientist III develops advanced analytics solutions utilizing AI technologies, leading projects in predictive analytics and NLP to enhance healthcare operations and patient care.

Community-based Registered Nurse responsible for complex care management of dually-eligible enrollees. Conduct in-home and community assessments, develop and implement care plans, coordinate with providers and community resources, lead interdisciplinary teams, assist with long-term supports and benefits navigation, provide education, perform post-hospital follow-up, and ensure adherence to NCQA and care management standards. Frequent travel within assigned Massachusetts territory required.

Senior BI/reporting role focused on LTSS & Dual Eligible programs. Develop ETL pipelines, complex reports, and interactive Power BI/Tableau dashboards; perform advanced data modeling, analysis, and governance to drive operational and clinical improvements.

Provide analytical support and lead claims-related projects: manage IT tickets, analyze claims data, resolve provider claim escalations, develop policies/job aides, assist training, report on OnBase and Facets, and support research and resolution activities for provider inquiries.

Design, implement, and lead multi-site data center and WAN network solutions (Cisco, Arista, Aruba). Own capacity planning, data center build-outs, SD-WAN architecture, cloud connectivity, vendor/colocation relationships, and incident root-cause analysis. Develop standards, lead high-risk maintenance, mentor engineers, and evaluate new networking technologies.

Lead end-to-end claims automation and AI initiatives: manage intake, prioritize based on ROI, design and implement solutions (RPA/GenAI/LLM), drive testing, adoption, and post-production value tracking across cross-functional teams.

Support operations with regulatory and compliance tasks: analyze claims data, manage audit and regulatory deliverables, draft policies and job aids, train business partners, track corrective actions and regulatory reporting, and collaborate with IT and business owners to resolve data and claims issues.

Manage and deliver LTSS and Dual Eligible programs across multiple projects: coordinate cross-functional teams, track milestones, budgets and KPIs, manage risks/issues, ensure compliance, run governance and stakeholder communications, and maintain program documentation and SharePoint repository.

The Actuarial Analyst II conducts analyses and provides recommendations to support corporate initiatives. This involves profitability reporting, evaluating assumptions and government reimbursement, and participating in cross-functional teams.

Design, validate, and operationalize predictive and machine learning models; mine and analyze large datasets; create visualizations and statistical validation; collaborate with teams to integrate solutions and communicate results to stakeholders.

The Behavioral Health Provider Engagement Specialist III manages provider contracting, recruitment, and engagement strategies, ensuring compliance and effective partnerships to enhance provider network performance.

Lead actuarial pricing, forecasting, reserving and modeling efforts. Develop assumptions, maintain actuarial models, evaluate financial experience, support rate filings and IBNR estimates, provide strategic recommendations, manage staff and vendor relationships, and report findings to leadership.

Lead provider relations and contracting strategies in Ohio, ensuring compliance and optimal performance while collaborating with stakeholders to enhance healthcare delivery.