Clinical Care Reviewer II NICU 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 s

The Quality Analyst III is responsible for analyzing and interpreting complex healthcare data. This role will collaborate with cross functional teams, providing analytical insight to inform strategy and interventions to drive improved quality performance Essential Functions Generate comprehensive reports, graphics and dashboards that effectively summarize and display data

The Triage Nurse is responsible for using decision support software to perform telephonic clinical triage and health information service for CareSource managed health plans and external clients. Essential Functions Utilize assessment skills and the nursing process for care of healthy, as well as acutely or chronically ill or injured clients, including pediatric, adult, ma

The Data Scientist III 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 Create, maintain, and communicate analytical plan for each project Balance progress in multiple

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, Dynamics Application Development is responsible for setting the vision and direction for SharePoint and the D365 Customer Relationship Management platform with best practices and understanding of the vision at CareSource IT. The role will have oversight over D365 and power platform development, system integrations, web services, API and data integration devel

The Quality Analyst IV is responsible for developing, implementing, modeling, and leveraging high volume and highly complex healthcare data to transform into advanced analyses or visual analytic solutions. This role will collaborate with cross functional teams, providing analytical insight to inform strategy and interventions to drive improved quality performance. Essenti

The Risk Adjustment Analyst III is responsible for compiling and analyzing member information to ensure the Risk Adjustment Factor accurately reflects the member health profile, financial and clinical information. Essential Functions Compile and analyze member information to ensure the Risk Adjustment Factor accurately reflects the member health profile, financial and cli

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

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