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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.
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