caresource
Market Chief Medical Director(Must Live In Michigan)
Job Summary: The Market Medical Director is responsible for the implementation of market-level clinical care standards and practice guidelines ensurin...
Senior Director, Clinical Data Governance and Integration
Job Summary: The Senior Director, Clinical Data Governance & Integration is responsible for developing, executing and coordinating enterprise clinical...
Sr. Manager, Medical Risk Adjustment Analytics
Job Summary: The Senior Manager, Medical Risk Adjustment Analytics is responsible for the day to day operations of the risk adjustment function across...
Community Based Care Manager
Job Summary: The Community Based Care Manager collaborates with members of an inter-disciplinary care team (ICT), providers, community and faith-based...
Revenue Cycle Coordinator III
Job Summary: The Revenue Cycle Coordinator III is responsible for providing oversight in the research and resolution of member related eligibility and...
Clinical Care Reviewer II - Nevada Licensed - RN - PST Hours
Job Summary: Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care se...
Clinical Care Reviewer II - RN -Multi State License - UM Experience
Job Summary: Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care se...
Applied AI Scientist III
Job Summary: The Applied AI Scientist III is responsible for the development and application of cutting-edge advanced analytics solutions using emergi...
CareSource Legal Intern
Job Summary: CareSource is looking for talented candidates to join its in-house legal department team. The internship is designed to develop the skill...
Clinical Audit Specialist - Utilization Management
Job Summary: The Clinical Audit Specialist - Utilization Management is responsible for conducting retrospective and focused audits of medical necessit...
Hybrid Registered Nurse (RN) Care Manager - Brooklyn
Job Summary: The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and ...
Hybrid Registered Nurse Care Manager - Queens
Job Summary: The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and ...
Regulatory Affairs Director - Hybrid
Job Summary: The Regulatory Affairs Director is responsible for leading activities of the Regulatory Affairs Department, including contracts, complian...
Care Guide Plus
Compensation Range: $47,400.00 - $76,000.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as ...
Community Care Manager - RN in Franklin County
Job Summary: The Community Based Care Manager in Franklin County collaborates with members of an inter-disciplinary care team (ICT), providers, commun...
Community Based Care Coordinator - Duals Integrated Care
Job Summary: The Community Based Care Coordinator, Duals Integrated Care is responsible for managing and coordinating care for dual-eligible beneficia...
Community Based Care Manager - RN in Hamilton County
Job Summary: The Community Based Care Manager in Cuyahoga County, OH in collaborates with members of an inter-disciplinary care team (ICT), providers,...
Member Svc. Rep. - Bronx, NY
Job Summary: Responsible for receiving and handling incoming calls on the general 1-800 numbers and provide first call resolution for members and call...
CareSource AI Intern
Job Summary: The CareSource Artificial Intelligence (AI) Intern will collaborate with cross-functional teams supporting enterprise-wide AI initiatives...
Interoperability Product Owner
Job Summary: The Interoperability Product Owner is responsible for ensuring compliance with interoperability mandates and legal requirements, with a f...
Community Based Care Managers
TrueCare is a Mississippi non-profit, provider-sponsored health plan formed by a coalition of Mississippi hospitals and health systems throughout the ...
G&A Specialist II (Mississippi Hybrid)
TrueCare is a Mississippi non-profit, provider-sponsored health plan formed by a coalition of Mississippi hospitals and health systems throughout the ...
Sr Mgr, Quality Risk Adjustment (Health plan/MCO experienced)
Job Summary: The Senior Manager, Quality Risk Adjustment is responsible for overseeing the Quality Risk Adjustment (QRA) Medical Record Review (MRR) p...
Health Partner Engagement Coordinator III-Hybrid
Job Summary: The Health Partner Engagement Coordinator III provides high-level administrative support, data management, and operational coordination t...
Community Marketing Representative II
TrueCare is a Mississippi non-profit, provider-sponsored health plan formed by a coalition of Mississippi hospitals and health systems throughout the ...
Care Guide
Job Summary: The Care Guides are responsible for participating as a member of the inter-disciplinary Care Coordination Team to coordinate care for mem...
Community Health Worker
TrueCare is a Mississippi non-profit, provider-sponsored health plan formed by a coalition of Mississippi hospitals and health systems throughout the ...
Member Services Rep - Bronx, NY
Job Summary: Responsible for receiving and handling incoming calls on the general 1-800 numbers and provide first call resolution for members and call...
Clinical Psychologist
Job Summary: The Clinical Psychologist provides Behavioral Health coverage determination for utilization management to ensure members receive appropri...
Clinical Psychologist
Job Summary: The Clinical Psychologist provides Behavioral Health coverage determination for utilization management to ensure members receive appropri...
Clinical Psychologist
Job Summary: The Clinical Psychologist provides Behavioral Health coverage determination for utilization management to ensure members receive appropri...
Enterprise Medical Director - Behavioral Health
Job Summary: Enterprise Medical Director, Behavioral Health is responsible for the overall safety of patients with a BH diagnosis, with a special focu...
Behavioral Health Medical Director
Job Summary: The Behavioral Health Medical Director is responsible for the overall safety of patients with a BH diagnosis, with a special focus on saf...
Associate Behavioral Health Medical Director(Part Time)
Job Summary: The Associate Medical Director, Behavioral Health supports staff by providing training, clinical consultation, and clinical case reviews ...
Health Partner Incentive Manager
Job Summary: The Community Health Partner Incentive Manager is responsible for managing value-based reimbursement programs within an assigned market o...
Women & Children’s Health Outcomes Specialist I
Job Summary: The Women & Children’s Health Outcomes Specialist is responsible to execute quality monitoring reviews as defined by provider agreement t...
AVP, Network and Contracting
Job Summary: The Associate Vice President, Network and Contracting is responsible for the planning, execution, and strategic plan to build hospital, p...
PI Medical Coding Reviewer III (CPC, RHIT or RHIA required)
Job Summary: The Program Integrity Medical Coding Reviewer III generates comprehensive and concise in-depth reporting and analysis to track performanc...
AI Engineer III – AI Enablement
Job Summary: The AI Engineer III is the lead builder of the "Engine Room," responsible for the reliability, scalability, and observability of the Pant...
Community Based Care Manager
Job Summary: The Community Based Care Manager collaborates with members of an inter-disciplinary care team (ICT), providers, community and faith-based...
Housing Supports and Services Specialist III- NV
Job Summary: The Housing Supports and Services Specialist III -NV plays a vital role in administering the Housing Supports and Services Program, speci...
Provider Credentialing Specialist (Hybrid)
Job Summary: The provider Credentialing Specialist is responsible for facilitating the centralized credentialing process for the companys providers, a...
Hybrid Clinical Registered Nurse (RN) Educator - MLTC
Job Summary: The Clinical Nurse Educator is responsible for assisting in identifying learning and development needs for clinical staff. Assesses compe...
Systems Analyst III
Job Summary: The Systems Analyst III is responsible for leading research and analysis to identify systems impacted by requirements, possible interface...
Scrum Product Owner (ADO/ServiceNow Queries wanted)
Job Summary: 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 pr...
Sr. Director, Network Strategic Initiatives and Vendor Performance(Preferred Experience In Durable Medical Equipment & Preferred Location Northeast)
Job Summary: The Senior Director, Marketplace Performance and Strategy leads the development of the Marketplace program strategy across the enterprise...
Associate Director, Utilization Management - Behavioral Health - Massachusetts only
Job Summary: The Associate Director, Utilization Management – Behavioral Health assists UM leadership in leading and managing all functions within beh...
Senior Contract Manager (Hybrid)
Job Summary: The Senior Contract Manager is tasked with the responsibility of efficiently ensuring provider contract terms and rates are propagated th...
Associate Director, Compliance(Must Live In Indiana, Preferred Experience In Managed Care)
Job Summary: The Associate Director, Compliance is responsible for establishing a baseline of compliance risk, identifying areas of potential exposure...
PI Medical Coding Reviewer III (CPC, RHIT or RHIA required)
Job Summary: The Program Integrity Medical Coding Reviewer III generates comprehensive and concise in-depth reporting and analysis to track performanc...
Member Engagement Analyst III- Las Vegas-HYBRID
Job Summary: The Member Engagement Analyst III is responsible for contributing to the overall support of Member Services programs by coordinating proc...
Finance Vendor Governance Program Manager
Job Summary: The Finance Vendor Governance Program Manager is responsible for managing the enterprise vendor governance program, ensuring financial te...
Hybrid Registered Nurse (RN) Clinical Care Manager - Boston
Job Summary: The Clinical Care Manager-Massachusetts is a community based registered nurse responsible for providing monitoring, follow-up and clinica...
QAI Medical Economics Analyst II
Job Summary: The Medical Economics Analyst II is responsible for analyzing healthcare utilization to identify patterns, variation, and outliers as wel...
Business Insights & Planning Analyst III
Job Summary: The Business Insights & Planning Analyst III is responsible for the mergers & acquisition workstream, business planning, and work product...
Hybrid Registered Nurse (RN) Care Manager - MLTC - Brooklyn
Job Summary: The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and ...
Mom and Baby Care Manager - RN - Must reside in Nevada
Job Summary: The Care Manager collaborates with members of an inter-disciplinary care team (ICT), providers, community and faith-based organizations t...
Hybrid Registered Nurse (RN) Clinical Care Manager - Cambridge to Malden
Job Summary: The Clinical Care Manager-Massachusetts is a community based registered nurse responsible for providing monitoring, follow-up and clinica...
Director, Claims(Preferred Experience in Medicare and Must Live In New York)
Job Summary: This position is responsible for directing the overall functions of claims processing, including claims adjudication, provider relations,...
instED Customer Account Manager (Remote)
Job Summary: The Customer Account Manager is a key contributor to the instED team, He/She will have assigned accounts and will be responsible for all ...
instED Virtual Medical Control Physician-POOL (Part Time - $120.83 per hour/Remote/Massachusetts - Eastern Time)
Job Summary: Reporting to the Chief Medical Officer of instED, the Virtual Medical Control (VMC) Physician provides medical decision making, including...
Data Product Manager I
Job Summary: The Data Product Manager I is responsible for supporting the analytics and data strategy within the healthcare insurance space. In this r...
LTSS & Dual Eligible Program Report Developer IV
Job Summary: The LTSS & Dual Eligible Report Engineer IV will play a crucial role in utilizing data analytics to drive informed decision-making and op...
Payment Cycle Analyst II- Hybrid
Job Summary: The Payment Cycle Analyst II is responsible for providing analytical support and leadership for key Claims-related projects and initiativ...
Managing Actuary (Medicaid Rate Advocacy)
Job Summary: The Managing Actuary provides leadership and direction to ensure team goals and strategies are successfully achieved. Essential Functions...
Medical Director
Job Summary: The Medical Director is responsible for supporting staff by providing training, clinical consultation, and clinical case review for membe...
Mgr, Ohio Market Contracting- Managed Care- Healthcare-Leadership Experience
Job Summary: The Manager, Ohio Market Contracting is responsible for leading specialized contracting efforts, handle unique contracting situations, in...
Health Partner Network Manager-Contracting Experience Highly Preferred!
Job Summary: The Health Partner Network Manager executes the Health Partner contracting strategy, develops contract provisions based on cost, quality/...
IT Financial Analyst III (Azure Portal/Cloud experience)
The IT Financial Analyst III is responsible for the leading development of expense projections to support forecast and budget and monitor monthly vari...
Community Based Care Manager-Harris, Chattahoochee, Marion, Macon
Job Summary: The Community Based Care Manager collaborates with members of an inter-disciplinary care team (ICT), providers, community and faith-based...
Identity and Access Management Engineer III (Development experience is a must)
Job Summary: The Identity and Access Management (IAM) team is responsible for the administration of access to the workforce. Essential Functions: Eval...
Hybrid - Registered Nurse (RN) Clinical Care Manager - Salisbury and surrounding area
Job Summary: The Clinical Care Manager-Massachusetts is a community based registered nurse responsible for providing monitoring, follow-up and clinica...
Hybrid BH Clinical Care Manager (LICSW or LMHC) - Lynn and surrounding
Job Summary: The Clinical Care Manager-Massachusetts is a community based registered nurse responsible for providing monitoring, follow-up and clinica...
Claims Management Analyst III
Job Summary: The Claims Management Analyst III is responsible for leading eBusiness initiatives and coordination of activities across multiple functio...
Entitlement Specialist (Onsite/Local Travel)
Job Summary: The Entitlement Specialist is responsible for ensuring that members maintain continuous Medicaid eligibility by overseeing the timely com...
Child Welfare and Community Justice Liaison- (Hancock County or Forrest County Preferred)
TrueCare is a Mississippi non-profit, provider-sponsored health plan formed by a coalition of Mississippi hospitals and health systems throughout the ...
Community Based Care Coordinator I
Job Summary: The Community Based Care Coordinator I – Arkansas with oversight from the care coordination team is the member concierge and is the singl...
Medicare Sales Representative - Base Salary + Commission Opportunities (Must Reside in Ohio)
Are you ready to make a meaningful impact in the lives of Medicare beneficiaries? At CareSource, we’re looking for passionate individuals to join our ...
Hybrid Registered Nurse (RN) Care Manager - Brooklyn
Job Summary: The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and ...
Hybrid Registered Nurse (RN) Care Manager - Bronx/Westchester
Job Summary: The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and ...
Hybrid Registered Nurse (RN) Care Manager - Brooklyn
Job Summary: The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and ...
Hybrid Intake Registered Nurse (RN) - UAS Brooklyn
Job Summary: The Intake Nurse - RN is responsible for assessing potential new members for eligibility for the program and for explaining the program t...
Hybrid Intake Registered Nurse (RN) UAS - Queens
Job Summary: The Intake Nurse - RN is responsible for assessing potential new members for eligibility for the program and for explaining the program t...
Hybrid Registered Nurse (RN) Care Manager- Manhattan
Job Summary: The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and ...
Team Lead, Configuration Testing (SDET/Facets/AI/RPA background preferred)
Job Summary: The Team Lead, Configuration Testing is responsible for day-to-day activities surrounding the knowledge and insight around testing of med...
Intelligent Automation Developer II - UiPath/Agentic AI
Job Summary: The Intelligent Automation Developer II creates and implements Intelligent Process Automation using UiPath and/or Power Automate, Python-...
Manager, Predictive Analytics and Data Science- NLP/AI experience is a must
Job Summary: The Manager, Predictive Analytics and Data Science is responsible for serving as the leader, subject matter expert, teacher, and mentor o...
AI Solution Consultant
Job Summary: The AI Solution Consultant serves as the primary "Face of AI" for CareSource business units, acting as a strategic bridge between clinica...
Hybrid Registered Nurse (RN) Clinical Care Manager - Dorchester and surrounding areas
Job Summary: The Clinical Care Manager-Massachusetts is a community based registered nurse responsible for providing monitoring, follow-up and clinica...
Medical Director
Job Summary: The Medical Director is responsible for supporting staff by providing training, clinical consultation, and clinical case review for membe...
ElderServe - Manager, Finance & Accounting (Hybrid Onsite Bronx, NY)
Job Summary: This position will be a hybrid onsite position. Onsite days are Monday, Tuesday, and Thursdays. Wednesday and Friday optional work from h...
Care Navigator (Remote - Massachusetts)
Job Summary: The Care Navigator is responsible for conducting telephonic interactions, documenting service activities, and supporting administrative f...
SIU Investigator II (Must live in Michigan or surrounding states)
Job Summary: The Special Investigations Unit (SIU) Investigator II is responsible for investigating and resolving moderate complexity allegations of h...
Remote - Registered Nurse (RN) Clinical Care Reviewer - Massachusetts only - Direct UM experience strongly preferred!
Job Summary: Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care se...
Medical Director (REMOTE Appeals Medical Director - Pacific Standard Time, Managed Care Experience, Family Medicine, Internal Medicine-Pediatrics and Appeals Experience Preferred")
Job Summary: The Medical Director is responsible for supporting staff by providing training, clinical consultation, and clinical case review for membe...
Hybrid Care Coordinator, Massachusetts
Job Summary: The Care Coordinator - Massachusetts is the primary point of contact for a stratified panel of members whose role is to assist enrollees ...
REMOTE - Registered Nurse (RN) Utilization Reviewer - Massachusetts ONLY
Job Summary: Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care se...
AI Developer
Job Summary: The AI Developer plays a key role in designing, developing, and deploying intelligent solutions. This role is focused on solving complex ...
Registered Nurse (RN) Clinical Care Manager - Berkshire County Massachussetts
Job Summary: The Clinical Care Manager-Massachusetts is a community based registered nurse responsible for providing monitoring, follow-up and clinica...
Dynamics 365 Solution Architect
Job Summary: Responsible for the definition, oversight, coordination and development of technology designs, along with the related road maps and lifec...
Director, Finance - Market(Must Live In Nevada)
Job Summary: Director, Finance – Market provides financial oversight, leadership and support to the market/corporate and ensures the department proact...
Clinical Appeals Nurse
Job Summary: The Clinical Appeals Nurse is responsible for processing clinical appeals and attending state hearings within compliance and regulatory s...
Health Partner Network Manager- Managed Care Contract Negotiation Experience -Must Reside in Georgia!
Job Summary: The Health Partner Network Manager executes the Health Partner contracting strategy, develops contract provisions based on cost, quality/...
Community Based Care Manager - Clark County
Job Summary: The Community Based Care Manager collaborates with members of an inter-disciplinary care team (ICT), providers, community and faith-based...
Health Partner Incentive Analyst II - Nevada - Mobile
Job Summary: The Health Partner Incentive Analyst II is responsible for performing administrative functions around the set up and maintenance of healt...
Medical Director, Ohio Market(Geriatrics, Internal Medicine, Family Practice Preferred)
Job Summary: The Medical Director, Ohio Market is responsible for participating in the development, implementation and revision of the clinical care s...
Community Based Care Coordinator I - MUST RESIDE IN SEVIER COUNTY
Job Summary: The Community Based Care Coordinator I – Arkansas with oversight from the care coordination team is the member concierge and is the singl...
Clinical Appeals
Job Summary: The Clinical Appeals Nurse is responsible for processing clinical appeals and attending state hearings within compliance and regulatory s...
Triage Nurse Nights - Compact State Licensed RN
Job Summary: *Nights - every other weekend, every other holiday* *Shift differential* Essential Functions: Utilize assessment skills and evidence-base...
Clinical Appeals Nurse
Job Summary: The Clinical Appeals Nurse is responsible for processing clinical appeals and attending state hearings within compliance and regulatory s...
AI Python Engineer II
Job Summary: The AI Engineer II is responsible for software development related to generative AI solutions. The role will work closely with cross-func...
instED Virtual Medical Control (VMC) Nurse Practitioner - POOL((Part Time - $91.67 per hour/Remote/Pacific or Mountain Time)
Job Summary: Reporting to the Chief Medical Officer of instED, the Virtual Medical Control (VMC) Nurse Practitioner provides medical decision making, ...
Field Operations Specialist (Mobile) Bronx/Westchester
Job Summary: The Field Operations Specialist is responsible for conducting and coordinating home visits for the care management team, and responsible ...
Managing Actuary - Medicaid Rate Advocacy
Job Summary: The Managing Actuary provides leadership and direction to ensure team goals and strategies are successfully achieved. Essential Functions...
Community Health Worker - Ohio Mobile
Job Summary: The Community Health Worker participates as a member of the inter-disciplinary care team (ICT) to coordinate care for members. Essential ...
instED Virtual Medical Control Physician (Part Time - $120.83 per hour/Remote/Pacific or Mountain Time)
Job Summary: Reporting to the Chief Medical Officer of instED, the Virtual Medical Control (VMC) Physician provides medical decision making, including...
Care Coordinator (Care Manager) - Registered Nurse (RN), Social Worker, or Clinical Counselor
Job Summary: The Community Based Care Coordinator, Duals Integrated Care is responsible for managing and coordinating care for dual-eligible beneficia...
Health Partner Engagement Specialist II-Northern Nevada
Job Summary: The Health Partner Engagement Specialist II collaborates with key Health Partners in the development of specific strategies for enhanced ...