Jobs at CareSource

Lead formulary design and strategy across lines of business, manage the Value Assessment Committee, oversee formulary implementation with PBM, monitor drug pipeline, drive cost and outcome-focused KPIs, support rebate negotiations, ensure regulatory compliance, collaborate with clinical programs, analyze data for improvements, and manage, coach, and develop staff.

Lead cross-functional process redesigns and operational readiness for claims lifecycle and systems. Conduct ROI and cost-benefit analyses, manage policy and performance, advise leadership on change management, mentor junior analysts, and ensure regulatory compliance and operational excellence.

Support operations with regulatory and compliance tasks: analyze claims data, manage audit and regulatory deliverables, draft policies and job aids, train business partners, track corrective actions and regulatory reporting, and collaborate with IT and business owners to resolve data and claims issues.

Perform actuarial analyses and reporting to support management decisions: calculate profitability, prepare monthly IBNR reserves, evaluate reimbursement processes and assumptions, run ad-hoc studies to improve efficiency, MLR, and operating results, and contribute on cross-functional initiatives.

The Claims Management Analyst III leads eBusiness initiatives, manages EDI trading partners, ensures compliance, and analyzes performance for continuous improvement.

The Senior Manager leads DSNP bid strategy and execution, ensuring compliant submissions across states, managing risks, and coordinating cross-functional activities related to bid development.

The Senior Manager, DSNP Product Operations leads operational aspects of DSNP products, ensuring compliance, scalability, and efficiency through collaboration and performance oversight.

The Configuration Architect oversees the architecture for clinical system configurations, ensures alignment with business needs, evaluates solutions, and leads teams in implementing standards and guidelines while mentoring others in the department.

The Applied AI Scientist III develops advanced analytics solutions utilizing AI technologies, leading projects in predictive analytics and NLP to enhance healthcare operations and patient care.