Jobs at CareSource

Manages Life Services operations for Medicaid-eligible members in collaboration with executive leadership. Responsibilities include developing programs, supporting budgets and strategy, coordinating services, engaging stakeholders, and leading coaching, advocacy, and training staff. The role also oversees mentoring programs, workforce development, public-private partnerships, regulatory and community engagement, and frequent member, provider, and community visits.

Provides administrative support to the Market President and office, including preparing presentations, correspondence, reports, calendars, meetings, travel arrangements, expense reports, and meeting minutes. Serves as an office gatekeeper and coordinates facilities, shipping, equipment, visitor badges, and market events. Requires discretion, confidentiality, strong communication, organization, problem-solving, and Microsoft Office proficiency.

Design, develop, deploy, and maintain AI and machine learning solutions, including generative AI platforms, LLMs, RAG systems, and MLOps pipelines. Responsibilities include model training, validation, fine-tuning, cloud and containerized deployment, performance monitoring, data analysis, risk mitigation, and production integration. The role collaborates with data scientists, engineers, product teams, and leadership while evaluating emerging technologies, documenting solutions, and driving process improvements.

Lead enterprise employee relations strategy and governance; advise executives and HR partners on complex, high-risk matters; oversee investigations, policy standardization, training, and leader coaching; analyze ER and HR metrics to mitigate risk, improve performance, and drive organizational effectiveness and change.

Analyzes financial trends, budgets, forecasts, variances, investments, contracts, vendor spending, and cost-saving initiatives. Prepares management, board, audit, and strategic plan reporting; improves internal controls and financial reporting processes; implements reporting systems; supports corporate finance reviews and budgeting; and mentors associates. The role requires independent judgment, complex financial analysis, cross-functional communication, and leadership in a corporate finance environment.

Owns CareSource’s EDI platform vision, roadmap, backlog, and delivery. Translates healthcare, regulatory, and integration requirements into technical specifications; partners with engineering, architecture, QA, DevOps, trading partners, and business teams; coordinates releases and Agile delivery; monitors transaction performance, defects, SLAs, and platform telemetry; drives data quality, observability, automation, compliance, documentation, and continuous improvement across EDI capabilities.

Leads quality and population health analytics using advanced statistics, epidemiological study design, predictive modeling, and quality improvement methodologies. Collects and analyzes healthcare data, predicts HEDIS and STAR ratings, evaluates interventions, supports compliance reporting, and communicates findings to business and administrative leaders. The role requires collaboration with quality leaders and market owners to improve health outcomes and inform strategic decisions.

Manages information security risks, vendor and third-party risk reviews, mitigation plans, policy exceptions, and compliance reporting. Partners with stakeholders and Enterprise Risk Management to maintain risk policies within tolerance. Serves as a technical expert, supports risk awareness and accountability, monitors security controls, and contributes to operational goals. The role requires expertise in IT audit, security monitoring, access management, encryption, networking, incident response, SOX compliance, and project management.

Lead a small actuarial team responsible for pricing, forecasting, reserving, and actuarial modeling for supplemental benefits. Develop assumptions, evaluate experience and trends, support rate filings and IBNR reserve estimates, provide strategic recommendations, and ensure compliance with actuarial standards.

Senior BI/reporting role focused on LTSS & Dual Eligible programs. Develop ETL pipelines, complex reports, and interactive Power BI/Tableau dashboards; perform advanced data modeling, analysis, and governance to drive operational and clinical improvements.

Lead end-to-end claims automation and AI initiatives: manage intake, prioritize based on ROI, design and implement solutions (RPA/GenAI/LLM), drive testing, adoption, and post-production value tracking across cross-functional teams.

Manage day-to-day operations for national provider network programs: create integrated workplans, run program cadence, track milestones, manage risks/issues, synthesize executive reports, coordinate cross-functional teams, promote AI-enabled tools, and support leadership presentations to ensure timely delivery and alignment.

Lead enterprise adoption and toolchain integration for business analysis across federated teams. Design enablement curriculum, integrate standards and AI-enabled tooling (Azure DevOps, ServiceNow, Nexus, Power BI), build decision-oriented dashboards and leading indicators, drive adoption and governance, surface portfolio trends, and partner with stakeholders to improve delivery predictability and compliance.

Lead and manage actuarial functions including pricing, forecasting, reserves, and performance monitoring. Drive model/report/process improvements, support financial reporting and executive decision-making, represent actuarial expertise to regulators and stakeholders, and develop actuarial team capabilities.

Lead the actuarial function to drive pricing, forecasting, rate filings, and financial analysis. Develop statistical models, ensure regulatory compliance, mentor staff, support senior management and business development, and implement AI-enabled solutions to improve efficiency and insights.

Perform actuarial analyses and profitability reporting to support management decisions; calculate monthly IBNR reserves; evaluate reimbursement processes; run regular and ad-hoc data studies to improve efficiency, MLR, and operating results; participate in cross-functional initiatives and present findings to stakeholders.

Lead actuarial pricing, forecasting, reserving and modeling efforts. Develop assumptions, maintain actuarial models, evaluate financial experience, support rate filings and IBNR estimates, provide strategic recommendations, manage staff and vendor relationships, and report findings to leadership.