The Operations Specialist II provides analytical support and leadership for project impacting Claims and key internal Claims projects. Essential Functions Represent claims on cross functional project work teams Submit, monitor and prioritize IT tickets for the Claims department Review special projects and identify issue trends and potential resolutions Assist with Onbase

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 competent delivery of care and coordination of services and supports. Facilitates communication, coordinates c

The Clinical Operations Program Manager Mom & Baby Beginnings (MBB) is responsible for managing programs that are aligned to strategic objectives and meet business/contractual/regulatory requirements of the MBB and NICU programs including project plan development, workflow design, program tracking and enhancements. This role is responsible for supporting and maintaining t

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 competent delivery of care and coordination of services and supports. Facilitates communication, coordinates c

The Care Guides are responsible for participating as a member of the inter disciplinary Care Coordination Team to coordinate care for members, meeting their individual needs and the needs of the population. The Care Guide serves as a single point of contact for care coordination when there is no CCE or OhioRISE Plan and/or CME involvement & short term care coordination ne

The Manager of Broker & Field Sales will be responsible for supporting and executing on the established D SNP sales strategy. Essential Functions Act as the primary liaison between CareSource, the various contracted enrollment platforms and the broker community to ensure plan data is available and recruited brokers have requested the appropriate and access and can view pl

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 competent delivery of care and coordination of services and supports. Facilitates communication, coordinates c

The Facets Developer II is responsible for the designing, coding, testing, and analyzing software programs and applications including research, design, documenting and modifying throughout the production lifecycle. Essential Functions Understand business requirements to create solutions for business processes. Work in an Agile framework with Sprint Planning, Daily Scrum,

The Architect III is responsible for the system design and development of critical frontend platform elements that will support our Digital systems. Additionally, expected to play a key role in defining and delivering strategies to help our Digital platform scale at a national level. Essential Functions Partnerships Driving strong partnerships with our internal Cloud, Dev

The Manager, Provider Relations is responsible for overseeing and encouraging the collaboration with key Health Partners in the development of specific strategies for enhanced operational engagement. Essential Functions Oversee the ownership of the relationship with the Health Partner/Provider with a proactive focus on overall provider satisfaction and retention Assists w

The Customer Care Specialist I assists members or providers with routine service inquiries. Must live in Ohio Training Hours Monday Friday 8a 4 30p EST Post Training Hours Monday Friday 8a 8p EST Part time and Full time positions available Starting pay $18hr Essential Functions Resolve member or provider routine service inquiries; examples include claims processing, membe

The Care Guides are responsible for participating as a member of the inter disciplinary Care Coordination Team to coordinate care for members, meeting their individual needs and the needs of the population. The Care Guide serves as a single point of contact for care coordination when there is no CCE or OhioRISE Plan and/or CME involvement & short term care coordination ne

The Care Guides are responsible for participating as a member of the inter disciplinary Care Coordination Team to coordinate care for members, meeting their individual needs and the needs of the population. The Care Guide serves as a single point of contact for care coordination when there is no CCE or OhioRISE Plan and/or CME involvement & short term care coordination ne

The Manager, Provider Network Performance provides leadership and direction to staff to ensure the goals of the department are successfully achieved. Essential Functions Ensure accurate and timely implementation of new Value Based Reimbursement (VBR) initiatives Lead value based reimbursement team projects focused on the continued development and automation of VBR program

The Member Health Assessor engages with the member to establish an effective, professional relationship with primary responsibility to conduct a standardized Health Risk Appraisals (HRA). Essential Functions Verify eligibility, previous enrollment history, demographics and current health status of each member prior to outreach Engage the member to gather information to as