The Data Scientist II is responsible for designing and validating predictive models, machine learning models, and artificial intelligence that inform and improve business processes across the organization (operational, clinical, financial, marketing, etc.). Essential Functions Mine and analyze large structured and unstructured datasets Develop visualizations that demonstr

The Pharmacy Technician II Rx Solutions Center (RSC) is responsible for handling member, pharmacy, and provider calls related to pharmacy clinical campaigns. This role will require collaboration across different areas within CareSource to ensure best in class service is delivered to our members. Essential Functions Performs technical and clerical duties that do not requir

The Financial Analyst I assists in the analysis for utilization and financial trends, costs, revenues, financial commitments and obligations incurred to predict future revenues and expenses. Essential Functions Highly involved in the development, production, and validation of reports from detailed claims, eligibility, pharmacy and clinical data Compile and analyze financi

CareSource is looking for talented candidates to join its in house legal department team. The internship is designed to develop the skills and abilities of future attorneys, as well as to identify and attract talent to our organization. Interns will have the opportunity to learn about CareSource's culture of commitment to its members and mission and how the in house legal

The Director, Quality Risk Adjustment Operations manages the operational execution of insourced and outsourced risk adjustment programs for all products MA/MMP/DSNP (Hierarchical Condition Category/HCC), Marketplace (Department of Health & Human Services/HHS), Medicaid (CDPS Rx), and expansion products by developing and implementing operational processes and program manag

The Risk Adjustment Analyst II provides analysis, extracts, review and reporting of data (must have solid SQL experience) to ensure accuracy and completeness and identify areas of risk and opportunity. This position is full time, remote. Essential Functions Compile and analyze member information to ensure the Risk Adjustment Factor accurately reflects the member health pr

The Health Plan Operations Analyst I reviews and analyzes the effectiveness and efficiency of existing market operation processes and systems and participates in development of solutions to improve or further leverage these functions. Essential Functions Participates in the development of new market operation initiatives from concept to implementation and provide statisti

The Health Partner Engagement Manager is responsible for working closely with managers to build, manage and maintain health partner relationships. Essential Functions Support Manager in meeting department financial cost savings goals Prepare for and participate in various meetings (to include Joint Operating Committees, Operations Meetings and Association Meetings) with k

The Manager, Provider Network Performance provides leadership and direction to staff to ensure the goals of the department are successfully achieved. Essential Functions Ensure accurate and timely implementation of new Value Based Reimbursement (VBR) initiatives Lead value based reimbursement team projects focused on the continued development and automation of VBR program

The Customer Care Specialist I assists members or providers with routine service inquiries. Must live in Ohio Training Hours Monday Friday 8a 4 30p EST Post Training Hours Monday Friday 8a 8p EST Part time and Full time positions available Starting pay $18hr Essential Functions Resolve member or provider routine service inquiries; examples include claims processing, membe

The Scrum Product Owner fulfills the role of Scrum Product Owner as defined by the principles of Scrum to maximize the value of the IT product and work of the development team. Essential Functions Develop the strategic vision for an IT product Work closely with the Scrum team to maintain focus on goals, alignment with business needs and urgent matters, and adherence to st

The Enterprise Accreditation Specialist III is responsible for supporting the organization to obtain and maintain appropriate accreditations, distinctions and recognitions through NCQA, URAC or other accrediting bodies. This person will serve as the subject matter expert for various accreditations, including but not limited to NCQA Health Plan Accreditation, LTSS Distinct

The Special Investigations Unit (SIU) III is responsible for investigating and resolving high complexity allegations of healthcare fraud, waste and abuse (FWA) by medical professional, facilities, and members. Researches, gathers, and analyzes data to identify trends, patterns, aberrancies, and outliers in provider billing behavior. Serves as a subject matter expert for o

The Operations Specialist II provides analytical support and leadership for project impacting Claims and key internal Claims projects. Essential Functions Represent claims on cross functional project work teams Submit, monitor and prioritize IT tickets for the Claims department Review special projects and identify issue trends and potential resolutions Assist with Onbase

The Special Investigations Unit (SIU) III is responsible for investigating and resolving high complexity allegations of healthcare fraud, waste and abuse (FWA) by medical professional, facilities, and members. Researches, gathers, and analyzes data to identify trends, patterns, aberrancies, and outliers in provider billing behavior. Serves as a subject matter expert for o