Jobs at CareSource

Lead enterprise internal communications strategy and execution; advise senior leaders; craft clear messaging for change, compliance, and campaigns; oversee channels and functional communications; manage deliverables, crisis communications, and measurement to improve employee engagement and alignment.

Lead cloud, DevOps, and SRE architecture efforts to scale CareSource's digital platform. Partner with Cloud, DevOps, Security, and SRE teams to design infrastructure, build Terraform templates, enhance CI/CD pipelines, implement monitoring/alerting, and improve reliability, scalability, and incident response for enterprise-scale digital products.

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.

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.

Serve as the subject matter expert for NCQA and other accreditations, working with business owners to identify gaps, prepare and submit materials, maintain accreditation roadmaps, track deliverables, monitor surveys, implement mitigation plans, provide training, and mentor junior staff to ensure compliance with accreditation standards.

Lead capture and proposal strategy for Medicaid procurements across the full solicitation lifecycle. Coordinate cross-functional teams, develop win themes, manage schedules, ensure compliance, produce high-quality RFP responses, and support oral presentations, BAFOs, and implementation handoffs.

Lead operational and compliance oversight for Utilization Management. Drive process improvements, assess data for regulatory alignment, implement changes, collaborate with clinical, analytics, and compliance teams, support parity and NQTL submissions, manage change initiatives, and recommend UM strategy and product filing actions to maintain accreditation and regulatory requirements.

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, represent actuarial expertise to regulators and executives, and align actuarial inputs with finance for monthly financial reporting and strategic decision-making.

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.

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.

Design, validate, and operationalize predictive and machine learning models; mine and analyze large datasets; create visualizations and statistical validation; collaborate with teams to integrate solutions and communicate results to stakeholders.

Lead oversight and monitoring of operations regulatory requirements, HEDIS initiatives, and SOC-1 controls. Mentor analysts, perform audits and monthly quality reviews across claims, provider appeals, enrollment and provider services. Identify risks, controls, and process gaps; drive process-improvement initiatives; track financial savings and costs; generate in-depth reports and recommendations; work cross-functionally with limited supervision.

Lead enterprise data platform strategy, architecture, engineering, integration, quality, and operations. Drive cloud modernization, scalable ETL/ELT, data governance, observability, MDM, interoperability, and platform reliability to support analytics, AI, regulatory compliance, and business outcomes. Build and manage senior data engineering and operations teams, vendor relationships, and budgets.

Senior technology leader owning enterprise BI, analytics, data science, and AI strategy. Leads BI, Data Science, and ML Engineering teams; drives model development, MLOps, governance, regulatory compliance (HIPAA/CMS), generative AI adoption, vendor decisions, and executive reporting to improve clinical, financial, and operational outcomes.

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.