Jobs at CareSource

Lead cross-functional process redesigns and operational readiness for claims lifecycle and systems. Conduct ROI and cost-benefit analyses, manage policy and performance, advise leadership on change management, mentor junior analysts, and ensure regulatory compliance and operational excellence.

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 oversight and monitoring of operations regulatory requirements, SOC-1 controls, and HEDIS initiatives. Mentor analysts, perform quality reviews and audits of claims and provider processes, analyze findings, produce reports with recommendations, and drive process-improvement initiatives while tracking related financial impacts.

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.

Perform actuarial analyses and reporting to support management decisions: calculate profitability, prepare monthly IBNR reserves, evaluate reimbursement processes and assumptions, run ad-hoc studies to improve efficiency, MLR, and operating results, and contribute on cross-functional initiatives.

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

The Manager of Finance & Accounting oversees monthly reporting, budget process, financial analysis, compliance, and team management while ensuring effective financial operations and strategic planning.

Lead and facilitate quality improvement initiatives focused on HEDIS and managed care outcomes. Perform process and gap analyses, manage improvement teams, document and implement PDSA cycles, measure outcomes, analyze survey and vendor data, prepare reports, train staff on improvement tools, and support compliance with federal/state regulations and accreditation standards.

Lead SIU investigator responsible for identifying and mitigating Medicaid/Medicare fraud, liaising with state and federal regulators, using data analytics to detect FWA, mentoring investigators, managing complex investigations, ensuring regulatory reporting accuracy, and coordinating corrective actions and legal processes.

Lead provider contracting, recruitment, and engagement for an assigned market. Negotiate and manage hospital, physician, ancillary, and behavioral health contracts; analyze financial and performance data; support value-based reimbursement and population health initiatives; coordinate credentialing/loading; mentor staff; ensure regulatory compliance and participate in joint operating committees to drive provider performance and satisfaction.

Lead provider contracting, recruitment, engagement, and performance initiatives for an assigned market. Negotiate contracts, analyze financial and quality data, support value-based reimbursement and practice transformation, coordinate with analytics and population health, mentor new hires, and ensure regulatory and accreditation compliance while managing heavy territory travel.

Create and manage corporate messaging and content that complies with brand and regulatory standards. Develop external and internal communications assets, coordinate thought leadership and speaking opportunities, support campaigns with internal and external partners, track performance, identify process improvements, and assist on special projects.

The Claims Management Analyst III leads eBusiness initiatives, manages EDI trading partners, ensures compliance, and analyzes performance for continuous improvement.

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.

The Senior Manager leads DSNP bid strategy and execution, ensuring compliant submissions across states, managing risks, and coordinating cross-functional activities related to bid development.

The Senior Manager, DSNP Product Operations leads operational aspects of DSNP products, ensuring compliance, scalability, and efficiency through collaboration and performance oversight.

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.

The Assistant Clinical Director manages care coordination, ensuring quality service delivery, staff performance, compliance with regulations, and operational oversight of clinical programs.

The DSNP Account Manager acts as a liaison between the organization and DSNP providers, ensuring operational alignment and support for program success through relationship management and education.