The Manager of Broker & Field Sales will be responsible for supporting and executing on the established D SNP sales strategy. Essential Functions Act as the primary liaison between CareSource, the various contracted enrollment platforms and the broker community to ensure plan data is available and recruited brokers have requested the appropriate and access and can view pl

The Clinical Operations Program Manager Mom & Baby Beginnings (MBB) is responsible for managing programs that are aligned to strategic objectives and meet business/contractual/regulatory requirements of the MBB and NICU programs including project plan development, workflow design, program tracking and enhancements. This role is responsible for supporting and maintaining t

The Investment Accountant III is responsible for performing the day to day accounting functions related to investment portfolios, with a focus on ensuring accurate and timely reporting of the investing activity in compliance with Generally Accepted Accounting Principles (GAAP), Statutory Accounting Principles (STAT) or other basis as deemed applicable. Essential Functions

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 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 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 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

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