Jobs at CareSource

Provide behavioral health utilization management, clinical oversight, and quality improvement for members. Develop and implement evidence-based policies, support regulatory/accreditation activities, consult with providers and state agencies, participate in fraud/quality investigations, and provide training and clinical support to staff and markets.

Serve as servant leader and coach for Scrum teams and the organization to adopt Agile/Scrum; facilitate ceremonies, remove impediments, track metrics, support Product Owner, improve processes, and manage stakeholder relationships to deliver projects.

Lead enterprise clinical data governance and integration: build/maintain clinical data inventory, standardize acquisition requirements, prioritize ingestion and interoperability (FHIR/HL7), oversee data quality and vendor performance, drive use cases from concept to deployment, partner with IT/Data Engineering, and manage a team of analysts to support governance and analytics roadmaps.

Lead actuarial team activities including pricing, forecasting, reserving, and model development. Produce strategic recommendations, manage actuarial processes and vendor work, support rate filings and regulatory interactions, oversee IBNR reserve estimates, and communicate results to leadership.

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.

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

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

Lead capacity planning, forecasting, and reporting for multi-site call centers. Develop staffing strategy and budgets, ensure accurate regulatory reporting, implement agent scorecards and speech analytics, drive Lean/Six Sigma continuous improvement, partner with WFM, engineering, finance, and talent acquisition to optimize staffing and operational performance.

Senior business analyst leading cross-functional teams to elicit and manage complex requirements, maintain Epics/Features lifecycle, align solutions to strategy, mentor analysts, drive process improvements, and present KPI-driven insights to stakeholders and executive leadership.

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.