Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services, assisting with discharge planning activities (i.e. DME, home health services) and care coordination for members enrolled with a CareSource Management Group line of business, as well as monitoring the delivery of healthcare servic

Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services, assisting with discharge planning activities (i.e. DME, home health services) and care coordination for members enrolled with a CareSource Management Group line of business, as well as monitoring the delivery of healthcare servic

The Health Partner Incentive Analyst II is responsible for performing administrative functions around the set up and maintenance of health partner incentives to ensure accurate and timely implementation of new value based health partner contracts. Essential Functions Research, gather and analyze data for contract modeling related to health partner capacity, assignment, an

The Customer Care Specialist I assists members or providers with routine service inquiries. Essential Functions Resolve member or provider routine service inquiries; examples include claims processing, member benefit education, contracting and credentialing requests, eligibility inquiries, and transportation arrangements Ensure all HIPAA and State requirements/regulations

The Medical Director is responsible for supporting staff by providing training, clinical consultation, and clinical case review for members. Essential Functions Provide prior authorization medical reviews, consultation and clinical review services Participate in peer to peer discussions Provide provider education, training, data sharing, performance evaluations and orient

The Manager, Market Clinical Quality & Accreditation ensures compliance with external Quality Review audits/studies, Performance Improvement Projects, and Quality Improvement Projects required by the Ohio Department of Medicaid, NCQA, and other accreditation bodies. Essential Functions Responsible for the review of QI issues regarding compliance with Federal, State, and A

The Medical Director is responsible for supporting staff by providing training, clinical consultation, and clinical case review for members. Essential Functions Provide prior authorization medical reviews, consultation and clinical review services Participate in peer to peer discussions Provide provider education, training, data sharing, performance evaluations and orient

The Operations Technical Business Analyst III is responsible to understand the stakeholder's business culture and priorities to effective identify business problems, assess proposed solutions, and represent the needs of stakeholders. Essential Functions Excel in all areas of requirements analysis, leveraging appropriate company and industry approaches and modeling techniq

The Community Based Care Manager collaborates with members of an inter disciplinary care team (ICT), providers, community and faith based organizations to improve quality and meet the needs of the individual, natural supports and the population through culturally competent delivery of care and coordination of services and supports. Facilitates communication, coordinates c

The Community Based Care Coordinator I Arkansas with oversight from the care coordination team is the member concierge and is the single point of contact for assessment, person centered planning, service coordination (funded or unfunded), disease management and transitions between all levels of care. Essential Functions Understand and implement person Centered thinking Fa

The Project Manager I is responsible for managing small complexity projects within programs or small complexity standalone projects. Essential Functions Responsible for successful delivery of project Ensure project milestone deliverables are completed and approved at every stage of the project lifecycle Assist with the continuous improvement of project management best pra

The Care Guides are responsible for participating as a member of the inter disciplinary Care Coordination Team to coordinate care for members, meeting their individual needs and the needs of the population. The Care Guide serves as a single point of contact for care coordination when there is no CCE or OhioRISE Plan and/or CME involvement & short term care coordination ne

The Community Based Care Manager collaborates with members of an inter disciplinary care team (ICT), providers, community and faith based organizations to improve quality and meet the needs of the individual, natural supports and the population through culturally competent delivery of care and coordination of services and supports. Facilitates communication, coordinates c

The Network Engineer III is responsible for evaluating, supporting, implementing and monitoring Network Management Toolsets. Essential Functions Design, implement, monitor and support Network Transport Infrastructure Cisco routers & switches, ISE, Application Load Balancers, CheckPoint firewalls, authentication services, wireless devices and DNS administration Monitor, su

The Client Engineer III is responsible for providing advanced IT support and engineering solutions for end user computing at our remote sites. They ensure that all client systems are operating efficiently and securely, leveraging expertise in desktop support, application deployment, patch management, and mobile device management. Essential Functions Provide deskside suppo