The Director, Risk & Insurance has overall responsibility for the organization's insurance and reinsurance programs. Essential Functions Lead the organization's captive reinsurance companies and look for ways to leverage captive structure Maintain relationships with brokers, carriers, and third party vendors Oversee the purchase of all insurance and reinsurance coverage f

The Operations Specialist III provides analytical support and leadership for key Claims related projects. Essential Functions Regulatory reporting such as CMS and Medicaid Prompt Pay Serve as high dollar claims reviewer Identify payment integrity issues with claims reimbursement methodologies Prepare and deliver responses to legal correspondence and state complaints Provi

The Architect III is responsible for partnering with many internal CareSource IT teams to design and implement critical outcomes in the Cloud, DevOps, and SRE domains intended to be leveraged by the Digital Solutions delivery teams. Additionally, expected to play a key role in defining and delivering strategies to help our Digital platform scale at a national level. Essen

The Architect III is responsible for the system design and development of critical frontend platform elements that will support our Digital systems. Additionally, expected to play a key role in defining and delivering strategies to help our Digital platform scale at a national level. Essential Functions Partnerships Driving strong partnerships with our internal Cloud, Dev

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 Director, Portfolio Management LTSS Delivery establishes a trusted advisor relationship with assigned strategic pillar executives and acts as primary liaison to ensure the delivery of assigned projects/programs. Essential Functions Integrate continuous improvement and innovation into all projects and programs for the assigned strategic pillar Provide support to VP EPM

The Claims Lifecycle Process Manager is responsible for leading and managing the efforts to improve the claim outcomes for existing and new lines of business within the Claims organization. This will involve working closely with cross functional teams to develop and execute project plans, manage risks, track progress, lead process improvement initiatives, and drive change

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 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 Facets Developer II is responsible for the designing, coding, testing, and analyzing software programs and applications including research, design, documenting and modifying throughout the production lifecycle. Essential Functions Understand business requirements to create solutions for business processes. Work in an Agile framework with Sprint Planning, Daily Scrum,

The Enterprise Data Architect is responsible for designing, creating, and managing CareSource's enterprise wide data architecture. This role is critical in establishing a solid foundation for data management and data processing flow throughout the CareSource ecosystem, ensuring that data is organized, accessible, secure, and aligned with business objectives. The Enterpris

The Manager, Medical Risk Adjustment Programs & Operations is responsible for managing performance, activities and SLAs of outside vendors who are partnered with for risk adjustment interventions. This position is full time, remote. Essential Functions Operates in a matrix environment influencing and managing collaborative risk adjustment initiatives with other internal f

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 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 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