Jobs at CareSource

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 enterprise employee relations strategy and governance; advise executives and HR partners on complex, high-risk matters; oversee investigations, policy standardization, training, and leader coaching; analyze ER and HR metrics to mitigate risk, improve performance, and drive organizational effectiveness and change.

Analyze complex healthcare quality data and develop reports, dashboards, graphics, and management summaries. Identify trends and variation, interpret HEDIS and other quality reporting requirements, refine analytics requests, and provide technical guidance on SQL, SAS, DAX, and visualizations. Collaborate with business partners and IT teams to improve reporting systems, support population health and pharmacy quality initiatives, and lead analytic efforts.

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.

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.

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 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.

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.

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.

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.

Perform actuarial analyses and profitability reporting to support management decisions; calculate monthly IBNR reserves; evaluate reimbursement processes; run regular and ad-hoc data studies to improve efficiency, MLR, and operating results; participate in cross-functional initiatives and present findings to stakeholders.

Lead actuarial pricing, forecasting, reserving and modeling efforts. Develop assumptions, maintain actuarial models, evaluate financial experience, support rate filings and IBNR estimates, provide strategic recommendations, manage staff and vendor relationships, and report findings to leadership.