CareSource

Community Manager

• Engage members in community-based settings and establish effective care coordination relationships
• Serve as a liaison between healthcare providers, community resources, and dual-eligible beneficiaries
• Conduct comprehensive assessments of physical, mental, and social needs
• Develop and implement individualized medical, social, and behavioral health care plans
• Lead and collaborate with interdisciplinary care teams
• Help members access housing, transportation, food assistance, and social services
• Educate members and families about Medicare, Medicaid, chronic conditions, medication adherence, and preventive care
• Promote healthy lifestyle choices and self-management
• Monitor health status and care plan adherence and adjust plans as needed
• Follow up after hospitalizations and significant health events to support continuity and prevent readmissions
• Coordinate with physicians, specialists, providers, community organizations, state agencies, and other stakeholders
• Participate in care team meetings and address barriers to care
• Maintain accurate records of member interactions, care plans, and outcomes
• Collect and analyze data to evaluate care coordination effectiveness
• Advocate for beneficiary needs and empower members in healthcare decisions
• Evaluate member satisfaction and address concerns
• Travel regularly for member, provider, and community-based visits
• Report abuse, neglect, or exploitation of older adults as a mandated reporter
• Perform assigned on-call responsibilities
• Adhere to NCQA and CMSA standards
• Perform other related duties as requested

Community Based Care Coordinator – Duals Integrated Care

Clinical Reviewer

• Process medical necessity reviews for authorization appropriateness of behavioral health care services
• Assist with discharge planning activities, including outpatient services and home health services
• Coordinate care for members
• Complete prospective, concurrent, and retrospective reviews of Behavioral Health services
• Identify, document, communicate, and coordinate care with collaborative care partners to facilitate transition to an appropriate level of care
• Engage with the medical director when additional clinical expertise is needed
• Maintain knowledge of state and federal regulations, State Contracts, Provider Agreements, benefits, and accreditation standards
• Identify and refer quality issues to Quality Improvement
• Identify and refer appropriate members for Care Management
• Provide guidance to non-clinical staff and support to LPN staff
• Attend medical advisement and State Hearing meetings as requested
• Assist the Team Leader with special projects or research as requested
• Perform other job-related duties as requested

Clinical Care Reviewer II – Behavioral Health, Prefer MA Licensed

Administrative Assistant

• Meet the administrative needs of the executive and assigned organization
• Compose and prepare advanced business presentation documents and spreadsheets
• Assist with special projects, conduct research, compile data and maintain records
• Compose correspondence related to administrative matters and general office policies for executive approval
• Gather and prepare reports for executive consideration and approval
• Answer telephone calls, provide information, direct calls or take messages concerning department matters
• Schedule and maintain calendars of appointments and meetings, including securing meeting rooms and preparing agendas
• Anticipate and prepare materials for conferences, correspondence, appointments, meetings and telephone calls
• Coordinate and secure executive travel arrangements and prepare itineraries
• Coordinate and prepare expense reports
• Attend meetings, record minutes and prepare them for distribution
• Establish and file documents, records and reports
• Maintain high-level knowledge of department activities
• Prepare responses to correspondence containing routine inquiries
• Perform other job duties as requested

Administrative Assistant III

Customer Support

• Serve as a subject matter expert while staffing the assist line and responding accurately to inquiries from Customer Care Specialists
• Handle and resolve escalated calls from members and providers
• Act as a New Hire Transition Coach for new employees
• Identify process gaps and partner with the Business Integration Team to resolve them
• Provide peer-to-peer feedback and identify training needs for Customer Care Specialists
• Manage and process incoming work from route boxes, faxes, email, web inquiries, and ServiceNow queues
• Partner with other departments to achieve internal service levels
• Maintain SME status through self-education and procedural updates
• Document second-level support questions in the Assist Line Tracking Database
• Assist members and providers with routine service inquiries
• Research, follow up on, and resolve open or pending issues
• Create and conduct departmental training as business needs require after completing CareSource University Functional Facilitator certification
• Perform other duties as requested

Customer Care Resolution Specialist

• Resolve routine member, beneficiary, or provider service inquiries, including claims processing, member benefit education, contracting and credentialing requests, eligibility inquiries, and transportation arrangements when applicable
• Ensure compliance with HIPAA and state and federal requirements and regulations
• Research, follow up on, and resolve open or pending issues in a timely manner
• Build and strengthen member or provider relationships through quality customer service
• Maintain knowledge of processes and procedures
• Adhere to departmental and company policies and procedures
• Maintain complete and accurate documentation of telephone and written communications
• Mentor new hire employees
• Perform other job-related instructions as requested

Customer Care Specialist I – Healthcare, Medicare Experience

Clinical Operations

• Design, develop, build, implement, and integrate clinical program workflows and system designs
• Develop and manage clinical programs through data analysis, project planning, workflow design, system design, tracking, and implementation
• Support continuous improvement through Plan-Do-Study-Act (PDSA) reviews
• Monitor and track model impact requests, workflows, product performance, and program performance
• Collaborate with Training and Auditing teams on program materials, system workflows, assessments, system design, and updates
• Collaborate with Clinical Operations Clinical Systems Configuration teams on program design, system build, and reporting capabilities
• Support new business activities, including RFP responses and clinical model implementation
• Collaborate with Informatics, Analytics, and Reporting teams to align process changes with metrics and reporting standards
• Work with executives, stakeholders, and leaders across markets and products to align programs with strategy, regulatory requirements, and resourcing
• Provide regular reporting and ongoing communications to senior management, stakeholders, and executive sponsors
• Represent the clinical operating model in intake, governance, and prioritization processes
• Monitor outcomes to identify opportunities for improvement in program design and application
• Perform other duties as requested

Clinical Operations Program Manager – Operating Model

AI Research Scientist

• Establish technical direction and lead design, development, and operationalization of advanced AI solutions for healthcare operations, patient outcomes, and organizational performance
• Lead evaluation of emerging AI technologies and define enterprise adoption strategies
• Process and analyze unstructured healthcare data using NLP and deep learning techniques
• Provide technical leadership for AI solutions from ideation through enterprise-scale production deployment
• Influence enterprise AI roadmaps and strategy through technical expertise and strategic partnerships
• Establish technical standards, reusable frameworks, best practices, and governance for AI development, deployment, monitoring, and optimization
• Direct complex NLP, predictive analytics, and applied AI initiatives across multiple business domains
• Collaborate with IT, risk adjustment, program integrity, HEDIS, healthcare operations, finance, and clinical teams
• Develop and implement predictive models, algorithms, and statistical techniques using large healthcare datasets
• Define and execute evaluation strategies for ML and LLM solutions, including quality metrics, bias and safety checks, and post-deployment monitoring
• Conduct data cleansing, feature engineering, exploratory data analysis, and rigorous data analysis
• Define KPIs, metrics, dashboards, and reports with stakeholders to support decision-making
• Provide strategic guidance to senior leadership based on predictive modeling and data analysis
• Ensure HIPAA and PHI compliance, data integrity, model governance, and documentation
• Serve as a subject matter expert in AI, machine learning, NLP, Generative AI, and emerging technologies
• Mentor Applied AI Scientists, Data Scientists, and technical teams through code reviews, technical guidance, and architecture recommendations
• Evaluate Responsible AI practices, healthcare AI regulations, and governance requirements
• Perform other job-related duties as requested

Applied AI Scientist IV

Project Manager

• Manage small complexity projects within programs or small complexity standalone projects
• Ensure successful project delivery and completion of milestone deliverables throughout the project lifecycle
• Improve project management best practices, processes, and tools
• Complete project closure activities
• Refine project charters and coordinate business and IT resource assignments
• Develop and maintain project schedules, WBS, resource plans, forecasts, budgets, and project operations/support plans
• Schedule project audits and ensure EPMO Governance compliance
• Capture and consolidate EPMO, IT, and business project estimates
• Assess and control project scope, schedule, and budget change impacts
• Escalate issues to Business Owners, Program Managers, and EPMO Leadership as appropriate
• Maintain stakeholder matrices, RAID logs, SharePoint sites, and project document repositories
• Drive cross-functional communication between business and IT areas
• Develop project communication and training plans with Talent Development and Communications
• Schedule and facilitate status, stakeholder, program, and governance meetings
• Capture meeting notes, decisions, and action items
• Track and report project status, metrics, and budget to stakeholders
• Implement mitigation strategies and contingency plans
• Identify, log, assign, and manage project risks and issues
• Produce reports, business decision documents, meeting minutes, and notifications
• Perform other assigned duties

Architect

• Define, oversee, coordinate, and develop technology designs, related road maps, and lifecycle management
• Align efforts across technical architectural disciplines to develop innovative architectures and roadmaps
• Provide architecture guidance, governance, and recommendations supporting technical objectives
• Establish technology architecture strategy, goals, and objectives with department leadership
• Partner with Information Technology groups to promote architecture principles, standards, methods, and strategic direction
• Facilitate analysis, design, artifacts, and technical requirements validation for strategic initiatives
• Lead or participate in vendor architecture assessments and reviews
• Develop technical architectures to reduce cost, increase availability, improve security, enhance client experience, and increase flexibility
• Perform IT due diligence on growth opportunities and assess technology risks and opportunities concerning target companies
• Set day-to-day objectives and independently handle non-routine work within established boundaries
• Perform other job duties as requested

Architect II

• Meet the administrative needs of executives and the assigned Finance organization
• Compose and prepare advanced business presentation documents and spreadsheets
• Assist with special projects, conduct research, compile data, and maintain records
• Compose correspondence related to administrative matters and general office policies for executive approval
• Gather and prepare reports for executive consideration and approval
• Answer telephone calls, provide information, direct calls, or take department-related messages
• Schedule and maintain calendars of appointments and meetings, secure meeting rooms, and prepare agendas
• Anticipate and prepare materials for conferences, correspondence, appointments, meetings, and telephone calls
• Coordinate and secure executive travel arrangements and prepare itineraries
• Coordinate and prepare expense reports
• Attend meetings, record minutes, and prepare them for distribution
• Establish and file documents, records, and reports
• Maintain high-level knowledge of department activities
• Prepare responses to correspondence containing routine inquiries
• Perform other job duties as requested

Systems Engineer

• Perform analysis of Encounter data
• Understand the financial and clinical impact of changes and decisions to business processes to ensure Service Level Agreements are achieved
• Support Regulatory Data projects
• Review Encounter rejections and provide resolution of minor to complex data issues or process changes
• Provide Claims Encounter subject matter expertise for CMS, state agencies, and internal CareSource organizations
• Build and leverage relationships to support continuous improvement of Encounter Data business processes
• Support testing and delivery of processes to the business
• Participate in claims data processes to ensure accuracy and compliance with CMS and state agencies
• Participate in claims data management and readiness for state and governing entities
• Support claims data submissions and required SLAs through internal and external changes
• Identify inconsistencies and gaps to improve productivity, accuracy, data usability, procedures, and policies
• Support Claims Encounters regulatory reporting
• Support performance reporting and analysis, recommending enhancements, cost savings initiatives, and process improvements
• Monitor management and oversight metrics and reports
• Support Claims Encounter initiatives, including automation with IT and improvements to regulatory report development
• Support vendors and manage SLAs, regulatory requirements, and contractual metrics
• Maintain strategic relationships with internal and external stakeholders
• Contribute to or develop user stories and provide user story guidance for sprint planning
• Apply knowledge of claims payment methodologies, adjudication processing, and state Encounter regulations to maintain compliant reconciliation processes and SLAs
• Perform other duties as requested

Encounters Systems Analyst II

Manager

• Provide monitoring, follow-up, and clinical care management to dual-eligible enrollees with complex medical, behavioral, and social needs
• Engage enrollees in their homes and community settings
• Establish complex care management relationships while considering cultural and linguistic needs
• Liaise among healthcare providers, community resources, and enrollees
• Perform comprehensive, functional, crisis, and risk assessments
• Develop and update care plans with enrollees
• Lead interdisciplinary care teams and collaborate with internal and external peers
• Oversee utilization of long-term services and supports
• Assist members with housing, transportation, food assistance, and social services
• Educate members about Medicare and Medicaid benefits and available services
• Educate members and families about chronic conditions, medication adherence, and preventive care
• Promote healthy lifestyle choices and self-management
• Support preventive health strategies and gap closure
• Follow up after hospitalizations and significant health events to support continuity of care and prevent readmissions
• Coordinate with physicians, specialists, healthcare providers, community organizations, state agencies, and service providers
• Advocate for enrollee needs and preferences
• Evaluate member satisfaction and monitor concerns
• Conduct regular member, provider, and community-based visits
• Report abuse, neglect, or exploitation as a mandated reporter
• Adhere to NCQA and care management standards
• Perform other related duties as requested

Clinical Care Manager, LICSW/LMHC

Account Manager

• Design, implement, and continuously enhance enterprise vendor governance frameworks, policies, procedures, controls, and operating standards
• Lead Integrated Care vendor strategy across Dual Eligible, D-SNP, LTSS, and integrated care operations
• Build and maintain an integrated vendor partnership portfolio view covering contracts, implementation, capacity, cost, service levels, quality, risks, and ownership
• Partner with cross-functional leaders to translate business needs into scalable vendor solutions and governance requirements
• Lead governance committees and vendor review operations, including agendas, decision materials, outcomes, action tracking, and escalations
• Identify contracts, risks, performance trends, capacity constraints, and opportunities requiring governance review or executive action
• Establish and maintain vendor performance scorecards and management routines
• Lead vendor demand, capacity, and resource planning for Integrated Care Programs
• Coordinate vendor onboarding and operational readiness across contracting, staffing, equipment, access, training, workflows, data exchange, reporting, and go-live activities
• Develop and maintain governance playbooks for vendor selection, implementation, performance management, escalation, remediation, transition, renewal, expansion, and offboarding
• Track and escalate contract execution or vendor engagement outside established processes and drive remediation
• Own and maintain the Vendor Governance charter
• Assess business processes, identify gaps, and lead future-state process design
• Apply process improvement and project management methodologies to analyze root causes, implement changes, and monitor outcomes
• Drive continuous improvement of vendor partnership processes, tools, data, reporting, and metrics
• Operationalize regulatory, accreditation, contractual, and policy changes affecting vendors and Integrated Care Programs
• Maintain playbooks for new business, mergers, acquisitions, and market implementation vendor readiness
• Coordinate cross-functional workstreams, dependencies, timelines, and accountability
• Lead vendor and process implementation activities outside the centralized project management office
• Support regulatory submission activities through documentation, evidence, reviews, and approvals
• Lead the operational business Vendor Workstream within the Vendor Disability Advocacy Council
• Represent Integrated Care Vendor Governance and Strategy in forums and enterprise committees
• Prepare executive reporting, recommendations, decision materials, and escalation summaries
• Perform other job-related duties as requested

Manager, Integrated Care Strategic Partnerships

• Manage construction, renovation and reconfiguration projects
• Develop and track project budgets
• Oversee project work, schedules, quality and contracted vendors
• Coordinate occupancy planning and facility operations
• Collect proposals and manage purchase requisitions, invoices and facility work orders
• Develop project work plans and incorporate IT requirements
• Lead project meetings for construction and furniture reconfiguration projects
• Plan and lead individual moves and support re-stacking initiatives across multiple locations
• Maintain interior signage, furniture inventories, design and construction standards, and facility policies
• Track seating assignments, hires, role changes, terminations and moves in internal systems
• Coordinate furniture repairs and reconfigurations
• Maintain electronic records, budget tracking, project finish binders and furniture binders
• Establish and maintain a space facilitator network for space allocations and seating assignments
• Conduct ergonomic assessments and collaborate with HR as required
• Perform other duties as requested

Facilities Project Manager III, Corporate Real Estate Experience Required

• Provide monitoring, follow-up, and clinical care management to dually eligible enrollees with complex medical, behavioral, and social needs
• Engage enrollees in their homes and community settings to establish complex care management relationships
• Liaise among healthcare providers, community resources, and enrollees to support communication and care transitions
• Perform comprehensive, functional, crisis, and risk assessments
• Develop and implement care plans with enrollees and provide routine updates
• Lead interdisciplinary care teams and collaborate with internal and external peers
• Oversee utilization of long-term services and supports
• Help members access housing, transportation, food assistance, and social services
• Educate members and families about Medicare, Medicaid, chronic conditions, medication adherence, preventive care, and healthy lifestyle choices
• Support preventive health strategies and close care gaps
• Follow up after hospitalizations and significant health events to promote continuity and prevent readmissions
• Coordinate care with physicians, specialists, healthcare providers, community organizations, state agencies, and other service providers
• Advocate for enrollee needs and preferences
• Evaluate member satisfaction and monitor concerns
• Conduct regular member, provider, and community-based visits
• Report abuse, neglect, or exploitation as a mandated reporter under state law
• Adhere to NCQA and Care Management standards
• Perform other job-related duties as requested

Community Based Care Coordinator – Duals Integrated Care

Clinical Care Reviewer II – Behavioral Health, Prefer MA Licensed

Administrative Assistant III

Customer Care Resolution Specialist

Customer Care Specialist I – Healthcare, Medicare Experience

Clinical Operations Program Manager – Operating Model

Applied AI Scientist IV

Project Manager

Architect II

Administrative Assistant III

Encounters Systems Analyst II

Clinical Care Manager, LICSW/LMHC

Manager, Integrated Care Strategic Partnerships

Facilities Project Manager III, Corporate Real Estate Experience Required

RN Clinical Care Manager