Jobs at CareSource

Serve as the subject matter expert for NCQA and other accreditations, working with business owners to identify gaps, prepare and submit materials, maintain accreditation roadmaps, track deliverables, monitor surveys, implement mitigation plans, provide training, and mentor junior staff to ensure compliance with accreditation standards.

Provide high-level administrative support to executives: prepare presentations and reports, manage calendars and travel, handle correspondence, compile data, take meeting minutes, and maintain records. Support special projects and ensure confidentiality and professional office operations.

Develop and maintain partnerships with community stakeholders in targeted Ohio communities, support member recruitment and engagement, research community needs, advise leadership on strategic opportunities, coordinate JobConnect team activities, use regional data to inform outreach, and serve as primary local contact for the program.

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

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.

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.

Design, develop, test, and debug software according to technical specs. Run performance tests, analyze results, perform code reviews, assist deployments, and collaborate with admins and engineers. Maintain SDLC, CI/CD, and configuration management practices.

Lead enterprise internal communications strategy and execution; advise senior leaders; craft clear messaging for change, compliance, and campaigns; oversee channels and functional communications; manage deliverables, crisis communications, and measurement to improve employee engagement and alignment.

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.

Lead capture and proposal strategy for Medicaid procurements across the full solicitation lifecycle. Coordinate cross-functional teams, develop win themes, manage schedules, ensure compliance, produce high-quality RFP responses, and support oral presentations, BAFOs, and implementation handoffs.

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.

Manage day-to-day operations for national provider network programs: create integrated workplans, run program cadence, track milestones, manage risks/issues, synthesize executive reports, coordinate cross-functional teams, promote AI-enabled tools, and support leadership presentations to ensure timely delivery and alignment.

Provide community-based behavioral health clinical care management for dual-eligible enrollees: assessments, care planning, interdisciplinary team leadership, care coordination with providers and community resources, follow-up after hospitalizations, advocacy, and oversight of long-term services. Regular field visits and travel required; adhere to NCQA and care management standards.

Lead enterprise adoption and toolchain integration for business analysis across federated teams. Design enablement curriculum, integrate standards and AI-enabled tooling (Azure DevOps, ServiceNow, Nexus, Power BI), build decision-oriented dashboards and leading indicators, drive adoption and governance, surface portfolio trends, and partner with stakeholders to improve delivery predictability and compliance.

Lead and manage actuarial functions including pricing, forecasting, reserves, and performance monitoring. Drive model/report/process improvements, support financial reporting and executive decision-making, represent actuarial expertise to regulators and stakeholders, and develop actuarial team capabilities.

Lead the actuarial function to drive pricing, forecasting, rate filings, and financial analysis. Develop statistical models, ensure regulatory compliance, mentor staff, support senior management and business development, and implement AI-enabled solutions to improve efficiency and insights.