CareSource
Job Summary: The Community Based Care Manager Indiana Pregnancy Promise collaborates with members of an inter disciplinary care team (ICT) to meet the needs of the individual, natural supports and the population through culturally competent delivery of care and coordination…
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 peer to peer discussions Provide provider…
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 peer to peer discussions Provide provider…
Job Summary: The Team Lead, Clinical Care Review is responsible for providing direct oversight of Clinical Care Review (CCR) employees and overseeing day to day workflow within the CCR team. Essential Functions:Provide direct oversight of CCR employees and oversee day…
Job Summary: The Claims Reimbursement Analyst is responsible to support Claims Operations work including, implementation and management of product reimbursement strategy and process. Essential Functions:Execute and support the tasks to develop, implement and maintain reimbursement guidelines for assigned CareSource Products,…
Job Summary: The Health Partner Network Manager IV acts as the lead negotiator for high value, strategic health partners. Essential Functions:Execute the contracting strategy, develop provisions based on cost, quality/analysis and monitor key metrics for the assigned Market. Lead for…
Job Summary: The Care Coordinator Massachusetts is the primary point of contact for a stratified panel of members whose role is to assist enrollees in navigating their health care providing care planning and coordination of services, ensuring timely service delivery…
Job Summary: The Clinical Operations Business Analyst is responsible for the development of reports, analytics, and recommendations to ensure continuous process improvement and gap closure. This role reviews policies and regulatory requirements, analyzes data and creates recommendations to improve operational…
Job Summary: The Distribution and Processing Services Specialist I is responsible for all incoming and outgoing mail service functions including processing registered, certified, and overnight mail. This position works every day in office at our Dayton Ohio HQ. Essential Functions:Receive,…
Job Summary: The 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 with culturally competent delivery…
Job Summary: 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…
Job Summary: The 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 with culturally competent delivery…
Job Summary: The Member Health Assessor engages with the member to establish an effective, professional relationship with primary responsibility to conduct their health risk assessment. Essential Functions:Participate in the Integrated Care Coordination Team as needed Coordinate logistics to support care…
Job Summary: Intake Specialist I is a provider oriented role that is responsible for the intake of all authorization requests received via various methods into the Utilization Management department. The Intake Specialist I handles requests from providers, assists with reviewing…
Job Summary: The Pharmacy Technician II is responsible for data entry and review of submitted authorization requests, providing assistance to providers or pharmacies calling for assistance, and ensuring resolution for escalations received in the pharmacy department. Essential Functions:Review traditional and…
Job Summary: The Clinical Appeals Nurse is responsible for processing clinical appeals and attending state hearings within compliance and regulatory standards, clinical guidelines, and contractual obligations. Essential Functions:Responsible for the completion of clinical appeals and state hearings from all states…
Job Summary: The Team Lead, Clinical Care Review is responsible for providing direct oversight of Clinical Care Review (CCR) employees and overseeing day to day workflow within the CCR team. Essential Functions:Provide direct oversight of CCR employees and oversee day…
Job Summary: The Community Based Care Coordinator Nevada assists enrollees in navigating their health care providing care planning and coordination of services, ensuring timely service delivery and prompting continuity of care through coordinated outreach and engagement with members and providers.…
Job Summary: The Community Based Care Manager Plus collaborates with members of an inter disciplinary care team (ICT) to meet the needs of the individual, natural supports and the population through culturally competent delivery of care and coordination of services…
Job Summary: Clinical Operations – Business Strategy Lead serves a subject matter expert and serves as a liaison between internal clinical partners/designees to capture specific business requirements that must be performed by the Clinical Partner or Vendor and serves as…
Caresource is Oklahoma's largest family owned Durable Medical Equipment company, specializing in providing hospice patients equipment throughout the entire state of Oklahoma of Oklahoma & Fort Smith, Arkansas. We are looking for compassionate and customer service friendly individuals. We are…
Caresource is Oklahoma's largest family owned Durable Medical Equipment company, specializing in providing hospice patients equipment throughout the entire state of Oklahoma of Oklahoma & Fort Smith, Arkansas. We are looking for compassionate and customer service friendly individuals. We are…
Job Summary: 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…
Job Summary: The Community Based Care Coordinator, Duals Integrated Care is responsible for managing and coordinating care for dual eligible beneficiaries, those who qualify for both Medicare and Medicaid. This position focuses on integrating health services and community resources to…
Job Summary: The Community Marketing Representative III is responsible to develop strategy for productive relationships with Public and Private Community partners to promote membership growth and retention for any lines of business in the assigned territory. These lines of business…
Job Summary: The Pharmacy Technician II is responsible for data entry and review of submitted authorization requests, providing assistance to providers or pharmacies calling for assistance, and ensuring resolution for escalations received in the pharmacy department. Essential Functions:Review traditional and…