Jobs at CareSource

Develop complex healthcare reports, ETL solutions, databases, and Power BI dashboards for LTSS and Dual Eligible programs. Analyze multidimensional data, ensure governance and accuracy, identify operational improvements, and deliver actionable insights to leadership. The role translates business requirements into scalable reporting solutions, collaborates with clinical, operational, data engineering, and IT teams, and leads testing, process automation, visualization, and large cross-functional data projects.

Manages cross-functional operational projects supporting Utilization Management and Clinical Appeals, including market implementations, workflow improvements, audit readiness, regulatory compliance, reporting validation, vendor coordination, and process enhancement. Maintains project plans, tracks risks and deliverables, coordinates stakeholders, validates operational data, supports audits and corrective actions, and provides status reporting to leadership. Requires healthcare payer knowledge, project management experience, and clinical licensure.

Manages healthcare payer operational projects supporting Utilization Management and Clinical Appeals. Coordinates market implementations, workflow improvements, compliance initiatives, audit readiness, reporting validation, corrective actions, vendor activities, and cross-functional deliverables. Maintains project plans, metrics, documentation, and status reporting while partnering with operational, clinical, training, auditing, and leadership stakeholders. Requires healthcare experience, project management capability, clinical licensure, and knowledge of payer operations, Medicaid, Medicare, regulatory requirements, UM, and Clinical Appeals.

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.

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.

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.

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.

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 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.

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.