Jobs at CareSource

Leads hospital and provider value-based payment programs within Nevada, overseeing contract implementation, quality metrics, financial targets, provider engagement, reporting, compliance, and corrective action plans. Collaborates with health plans, hospitals, providers, and internal stakeholders to improve care quality, utilization, member experience, and incentive performance. Manages strategic provider performance initiatives, analyzes data, participates in committees, and supports Medicaid managed care objectives.

Directs market-specific healthcare quality improvement programs, ensuring compliance with NCQA and state requirements. Oversees quality plans, performance improvement projects, audits, corrective actions, data analysis, risk assessment, reporting, committees, and regulatory initiatives. Partners with enterprise stakeholders, represents the organization externally, supports budgeting and strategic planning, and leads quality outcomes for Medicaid or managed care markets.

The Director of Provider Contracting leads provider contracting strategy, negotiations, recruitment, onboarding, contract administration, reimbursement terms, and network adequacy. The role ensures regulatory and corporate compliance, manages claims-system contract testing, develops contract templates with legal, analyzes gaps and risks, supports access grievance initiatives, and improves provider satisfaction. It also supervises and develops staff, coordinates member reassignment after provider terminations, supports payment policies, and travels up to 30%.

Designs and deploys lightweight AI applications and user interfaces using low-code platforms, Python, SQL, and cloud data technologies. Translates generative AI, agentic AI, and NLP capabilities into scalable business workflows, collaborating with data engineering, data science, IT, and architecture teams. Responsibilities include application testing, troubleshooting, optimization, accessibility, compliance, production deployment, incident support, and Agile development. The role requires five years of application development experience and two years deploying cloud-based applications and modern data platforms.

Leads digital strategy, transformation, and roadmap development across member and provider experiences. Directs personalized engagement programs, omni-channel adoption, performance measurement, vendor partnerships, budgets, and digital teams. Aligns technology with business needs, defines customer journeys, promotes user-centered design, and drives organizational change. The role also hires and develops talent, presents digital vision to executives, and manages large initiatives under tight timelines.

Leads enterprise business analysis strategy across multiple programs and portfolios. Partners with executives on business cases, investment decisions, requirements, prioritization, risks, value realization, and transformation initiatives. Establishes governance, methodologies, standards, and performance measures while guiding complex requirements efforts. Analyzes operational and financial data, supports payer regulatory compliance, drives AI and automation adoption, and mentors business analysts and project teams.

Leads sales strategy and operations for the Military & Veterans business, focusing on enrollment growth, sales planning, analytics, dashboards, forecasting, market insights, field enablement, and executive reporting. Coordinates cross-functional sales initiatives, improves CRM and operational workflows, supports strategic planning, and partners with field representatives and business teams to optimize performance and execution.

Lead cloud, DevOps, and SRE architecture efforts to scale CareSource's digital platform. Partner with Cloud, DevOps, Security, and SRE teams to design infrastructure, build Terraform templates, enhance CI/CD pipelines, implement monitoring/alerting, and improve reliability, scalability, and incident response for enterprise-scale digital products.

Designs, validates, and operationalizes predictive, machine learning, and AI models using large structured and unstructured datasets. Performs statistical analysis, develops visualizations and dashboards, presents findings to stakeholders, and integrates solutions across teams. Provides clinical-program analytics, evaluates data science tools, mentors junior scientists, leads concurrent projects, and prepares end-to-end model pipelines for business use.

Leads provider network operations, value-based contracting, risk adjustment, quality improvement, financial planning, and strategic initiatives. Oversees provider relationships, network access, regulatory compliance, performance measurement, contract-management systems, vendor selection, and operational redesign. Develops market plans, represents the organization externally, presents recommendations to executives, and manages support teams, including hiring and development. Requires healthcare network management and leadership experience, with managed care experience preferred.

Provides administrative support to the Market President and office, including preparing presentations, correspondence, reports, calendars, meetings, travel arrangements, expense reports, and meeting minutes. Serves as an office gatekeeper and coordinates facilities, shipping, equipment, visitor badges, and market events. Requires discretion, confidentiality, strong communication, organization, problem-solving, and Microsoft Office proficiency.

Owns CareSource’s EDI platform vision, roadmap, backlog, and delivery. Translates healthcare, regulatory, and integration requirements into technical specifications; partners with engineering, architecture, QA, DevOps, trading partners, and business teams; coordinates releases and Agile delivery; monitors transaction performance, defects, SLAs, and platform telemetry; drives data quality, observability, automation, compliance, documentation, and continuous improvement across EDI capabilities.

Cultivates strategic relationships with healthcare providers, community organizations, LTSS entities, and advocacy groups to generate Medicare Advantage leads and enrollments. Develops community outreach and engagement plans, delivers presentations and educational events, trains partner staff, supports culturally competent market growth, and collaborates with sales, outreach, broker, and leadership teams. This mobile role requires extensive territory travel and participation in evening or weekend activities as needed.

Cultivates strategic relationships with healthcare providers, community organizations, LTSS entities, and advocacy groups to generate leads and enroll Medicare beneficiaries. Develops outreach plans, conducts presentations and educational events, trains partner staff, and supports membership growth in diverse communities while ensuring compliance with CMS and state regulations. The mobile role requires frequent territory travel, independent work, collaboration with sales leadership, and occasional evening or weekend availability.

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.

Leads quality and population health analytics using advanced statistics, epidemiological study design, predictive modeling, and quality improvement methodologies. Collects and analyzes healthcare data, predicts HEDIS and STAR ratings, evaluates interventions, supports compliance reporting, and communicates findings to business and administrative leaders. The role requires collaboration with quality leaders and market owners to improve health outcomes and inform strategic decisions.

Manages information security risks, vendor and third-party risk reviews, mitigation plans, policy exceptions, and compliance reporting. Partners with stakeholders and Enterprise Risk Management to maintain risk policies within tolerance. Serves as a technical expert, supports risk awareness and accountability, monitors security controls, and contributes to operational goals. The role requires expertise in IT audit, security monitoring, access management, encryption, networking, incident response, SOX compliance, and project management.

Lead market/region financial oversight and strategy, deliver reporting and forecasts, support budgeting and audits, manage finance staff, drive revenue maximization and regulatory filings, and partner with market leaders to meet targets.

Provide financial leadership and oversight for a region/market: reporting, budgeting, forecasting, regulatory filings, rate advocacy, risk and IBNR analysis, audit coordination, staff management, and strategic support to market and corporate leaders to meet targets.

Lead a small actuarial team responsible for pricing, forecasting, reserving, and actuarial modeling for supplemental benefits. Develop assumptions, evaluate experience and trends, support rate filings and IBNR reserve estimates, provide strategic recommendations, and ensure compliance with actuarial standards.