Teams 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.