CareSource Jobs

Care Navigator (Remote - Massachusetts)

Remote

Job Summary: The Care Navigator is responsible for conducting telephonic interactions, documenting service activities, and supporting administrative functions that enhance member satisfaction. Care Navigators also contribute to core operations including intake, triage,...

instED Virtual Medical Control Physician (Part Time - $120.83 per hour/Remote/Pacific or Mountain Time)

Remote

Job Summary: Reporting to the Chief Medical Officer of instED, the Virtual Medical Control (VMC) Physician provides medical decision making, including all elements of diagnostics, treatment, and disposition, to patients seen by instED's Mobile Integrated Healthcare service....

Medical Director (REMOTE Appeals Medical Director - Pacific Standard Time, Managed Care Experience, Family Medicine, Internal Medicine-Pediatrics and Appeals Experience Preferred")

Remote

Job Summary: 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...

instED Virtual Medical Control (VMC) Nurse Practitioner - POOL((Part Time - $91.67 per hour/Remote/Pacific or Mountain Time)

Remote

Job Summary: Reporting to the Chief Medical Officer of instED, the Virtual Medical Control (VMC) Nurse Practitioner provides medical decision making, including all elements of diagnostics, treatment, and disposition, to patients seen by instED's Mobile Integrated Healthcare...

Capture & Proposal Director

Remote

Job Summary: The Growth Director is responsible for managing capture and proposal strategy efforts throughout the entire life cycle of a procurement to win new and existing Medicaid business. Essential Functions: Partner with the Growth team, Health Plan leadership, and...

Operations Regulatory Specialist II (Dayton OH Hybrid location)

Remote

Job Summary: The Operations Regulatory Specialist II provides analytical support and leadership for key internal Operations projects and partners with the Operations departments to ensure all regulatory and compliance deliverables are met. This position will work Tues/Thurs...

Behavioral Health Medical Director

Remote

Job Summary: The Behavioral Health Medical Director is responsible for the overall safety of patients with a BH diagnosis, with a special focus on safe prescribing. Essential Functions: Assume responsibility for the overall safety of patients with a BH diagnosis, with a...

Medical Director

Remote

Job Summary: 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...

Operational Excellence Analyst III (Hybrid location preferred)

Remote

Job Summary: Operational Excellence Analyst III is responsible to take a leading role in the oversight and monitoring of Operations regulatory requirements, and Service Organization Control-1 (SOC-1) controls. Hybrid location- 2 days in Dayton, OH office and 3 days remote- is...

Utilization Management Operations Strategy and Implementation Lead

Remote

Job Summary: The Utilization Management (UM) Operations Strategy & Implementation Lead is responsible for maintenance and oversight of all operational and compliance activities that support the UM department. This role will also drive key process changes and identify key gaps...

Enterprise Accreditation Specialist III

Remote

Job Summary: 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...

Director, Integrated Care Learning & Development

Remote

Job Summary: The Director, Integrated Care Learning & Development, is accountable for the strategy, direction, and oversight of the cross-market Learning & Development function supporting Integrated Care, including LTSS, Duals and related lines of business. This role leads a...

Privacy Analyst III

Remote

Job Summary: The Privacy Analyst III is responsible for investigating privacy incidents, providing guidance to internal business partners on appropriate use and disclosure of Protected Health Information (PHI), and assists in maturing the privacy program. Essential Functions:...

Vendor Medical Coding Analyst

Remote

Job Summary: The Vendor Medical Coding Analyst is responsible for guiding the overall efficiency and accuracy of the vendor payment process through analyzing medical records and supplemental data to ensure diagnostic and procedural codes accurately reflect and support the...

Medical Director

Remote

Job Summary: 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...

Medical Director

Remote

Job Summary: The Clinical Appeals Medical Director will perform medical necessity review of appeals, within the organization, ensuring timely, accurate, quality and compliant review of clinical appeals. Administers the decision-making process related to appeals, supports...

Behavioral Health Medical Director

Remote

Job Summary: The Market Behavioral Health Medical Director is responsible for the overall safety of patients with a Behavioral Health diagnosis, with a special focus on safe prescribing. Essential Functions: Assume responsibility for the overall safety of patients with a...

Clinical Psychologist

Remote

Job Summary: The Clinical Psychologist provides Behavioral Health coverage determination for utilization management to ensure members receive appropriate and medically necessary care in the most cost-effective setting. Essential Functions: Assume responsibility for the...

Board-Certified Behavior Analyst(Must Have BCBA-D)

Remote

Job Summary: The Board-Certified Behavior Analyst serves as the clinical lead in developing and implementing evidenced based clinical policies and practices for members with Autism and their families Essential Functions: Oversee coverage determinations for ABA utilization...

Pharmacist I

Dayton WFH

Job Summary: Pharmacist I is responsible for supporting the department, operational strategies, goals and vision. Pharmacists shall utilize pharmaceutical and clinical expertise to review Prior Authorizations requests within a timely manner, to promptly serve our CareSource...

Manager, Field Sales (Ohio Residency is Required)

Remote

Job Summary: The Manager, Field Sales is responsible for leading and overseeing a team of sales representatives operating in the field to achieve enrollment targets and drive business growth. The Manager will analyze market trends, monitor team performance, provide coaching...

Operations Specialist II

Remote

Job Summary: 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...

Team Lead, Customer Care

Job Summary: The Team Lead, Customer Care is responsible for leading and directing their team to ensure goals, regulatory, compliance, and department standards are met. Essential Functions: Conduct regularly scheduled coaching conversations; listening and providing feedback...

Enterprise Medical Director

Job Summary: The Enterprise Medical Director is responsible for the development, implementation and revision of corporate level clinical care standards and practice guidelines, ensuring compliance with nationally accepted quality standards. Essential Functions: Development,...