SIU Investigator III (Must live in MA or surrounding states)
Caresource 4.9
Caresource job in Dayton, OH
The Special Investigations Unit (SIU) III is responsible for investigating and resolving high complexity allegations of healthcare fraud, waste and abuse (FWA) by medical professional, facilities, and members. Researches, gathers, and analyzes data to identify trends, patterns, aberrancies, and outliers in provider billing behavior. Serves as a subject matter expert for other investigators. Qualified candidates must live in Massachusetts or surrounding states.
Essential Functions:
Develop, coordinate and conduct strategic fact-driven investigative projects including business process review, execution of investigative activities, and development of investigation outcome recommendations
Manage the development, production, and validation of reports generated from detailed claims, eligibility, pharmacy, and clinical data and translate analytical findings into actionable items
Manage strategic investigative plan and drive investigative outcome for the team
Ensure quality outcomes for investigative team through auditing and oversight
Prioritize, track, and report status of investigations
Report identified corporate financial impact issues
Use concepts and knowledge of coding guidelines to analyze complex provider claim submissions
Research, comprehend and interpret various state specific Medicaid, federal Medicare, and ACA/Exchange laws, rules and guidelines
Identify, research and comprehend medical standards, healthcare authoritative sources and apply knowledge to investigative approach
Collaborate with data analytics team and utilize RAT STATS on Statistically Valid Random Sampling
Coordinate and conduct on-site and desk audits of medical record reviews and claim audits
Manage and decision claims pended for investigative purposes
Maintain a working knowledge of all state and federal laws, rules, and billing guidelines for various provider specialty types
Prepare and conduct in-depth complex interviews relevant to investigative plan
Execute and manage provider formal corrective action plans
Participate in meetings with operational departments, business partners, and regulatory partners to facilitate investigative case development
Participate in meetings with Legal General Counsel to drive case legal actions, formal corrective actions, negotiations with recovery efforts, settlement agreements, and preparation of evidentiary documents for litigation
Present, support, and defend investigative research to seek approval for formal corrective actions
Establish and maintain relationships with Federal and State law enforcement agencies, task force members, other company SIU staff and external contacts involved in fraud investigation, detection and prevention
SME in the designated market and ability to apply external intelligence to their analysis and case development
Develop and present internal and external formal presentations, as needed
Attend fraud, waste, and abuse training/conferences, as needed
Support regulatory fraud, waste, and abuse reports to federal and state Medicare/Medicaid agencies
Manage and maintain sensitive confidential investigative information
Maintain compliance with state and federal laws and regulations and contracts
Adhere to the CareSource Corporate Compliance Plan and the Anti-Fraud Plan
Assist in Federal and State regulatory audits, as needed
Perform any other job-related instructions, as requested
Education and Experience:
Bachelor's Degree or equivalent years of relevant work experience in Health-Related Field, Law Enforcement, or Insurance required
Master's Degree (e.g., criminal justice, public health, mathematics, statistics, health economics, nursing) preferred
Minimum of five (5) years of experience in healthcare fraud investigations, medical coding, pharmacy, medical research, auditing, data analytics or related field is required
Competencies, Knowledge and Skills:
Intermediate proficiency level in Microsoft Office to include Outlook, Word, Excel, Access, and PowerPoint
Effective listening and critical thinking skills and the ability to identify gaps in logic
Strong interpersonal skills, high level of professionalism, integrity and ethics in performance of all duties
Excellent problem solving and decision making skills with attention to details
Background in research and drawing conclusions
Ability to perform intermediate data analysis and to articulate understanding of findings
Ability to work under limited supervision with moderate latitude for initiative and independent judgment
Ability to manage demanding investigative case load
Ability to develop, prioritize and accomplish goals
Self-motivated, self-directed
Strong written skills with ability to compose detailed investigative reports and professional internal and external correspondences
Presentation experience, beneficial
Knowledge of Medicaid, Medicare, healthcare rules preferred
Background in medical terminology, CPT, HCPCS, ICD codes or medical billing preferred
Complex project management skills preferred
Display leadership qualities
Licensure and Certification:
One of the following certifications is required: Accredited Healthcare Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE)
Certified Professional Coder (CPC) is preferred
NHCAA or other fraud and abuse investigation training is preferred
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Occasional travel (up to 10%) to attend meetings, training, and conferences may be required
Compensation Range:
$72,200.00 - $115,500.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business
This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#LI-SD1
$72.2k-115.5k yearly 4d ago
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Manager, LTSS Program Operations
Caresource 4.9
Caresource job in Dayton, OH
The Manager, LTSS Program Operations assists the Duals team with open projects and progress towards completion, program enhancements, development, and execution activities related to implementation and ongoing design and standardization for the Dual eligible and LTSS model.
Essential Functions:
Collaborate with markets to implement business strategies and operational plans to ensure core functionality, scalability, and ongoing department management to support LTSS (HCBS and NH) model
Support the translation of business and program vision and strategy into operational tactics - collaborating to build the necessary organizational support and infrastructure
Support post implementation strategy and goals to mitigate program risks
Support the evaluation of operational process effectiveness for accomplishing market goals and objectives; manage operation process improvement activities in collaboration with market teams
Coordinate, translate, and execute key strategies for functional/ operational requirements
Provide leadership and support for product expansion
Incorporates industry standard, best practice project management tools and techniques in market initiatives
Recognizes and proactively manages operational dependencies and risks across market operations initiatives portfolio through effective change and risk management controls
Works closely with leadership to establish, communicate, and perpetuate the corporate vision, ensuring appropriate communication to stakeholders
Monitors performance across markets LTSSS/HCBS programs to leverage best practice and knowledge sharing for the purpose of improving outcomes through the standardization of evidence-based practices
Assists the dual eligible President with the monitoring of legislative/governmental activities with the goal of advocating for the full integration LTSS/HCBS standard model, identifying opportunities and issues
Interacts heavily within Dual Eligible, LTSS program business partners, and builds strong working relationships with all markets
Engages stakeholders to ensure alignment
Leads activities ensuring the delivery of high quality, consistent initiatives that result in optimum outcomes for members, providers, and program goals
Perform any other job related duties as requested.
Education and Experience:
High School or GED required
Bachelor's degree preferred
Four (4) years of clinical operations/healthcare administration experience required
Four (4) years of experience driving performance and process improvements, is in the health care insurance industry required
Three (3) years Experience with Government-regulated (Federal and/or State) health insurance products including Medicaid, Managed Care Waiver, FFS and Medicare preferred
Three (3) years Experience implementing programs with focus on integration preferred
Three (3) years Project management experience preferred
Competencies, Knowledge and Skills:
Able to effectively identify business problems, assess proposed solutions, and understand the needs of business partners and stakeholders
Ability to communicate effectively with all levels of leadership
Develops effective working relationships with business partners and stakeholders
Strong organizational, time management, analysis, and problem-solving skills
Ability to manage a project from start to finish
Strong relationship building skills and leadership qualities
Training and teaching skills/change agent
Ability to think critically and lead with strategy
Comprehensive knowledge base crossing all the following areas: Clinical Operations, Market Groups, Business Development, Network, and Operations
Hands on proficiency in Microsoft Office tools, including Project, Outlook, Word, PowerPoint, and Excel
Business acumen and politically astute ability to act with diplomacy and sensitivity to cultural diversity
Licensure and Certification:
None
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Up to 15% (occasional) travel based on the needs of the department may be required
Compensation Range:
$94,100.00 - $164,800.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business
This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#LI-GB1
$94.1k-164.8k yearly 18h ago
Quality Analyst II - Hedis Analytics
Caresource 4.9
Caresource job in Dayton, OH
The Quality Analyst II is responsible for analyzing and interpreting complex healthcare data. This role will collaborate with cross-functional teams, providing analytical insight to inform strategy and interventions to drive improved quality performance.
Essential Functions:
Generate graphics that effectively describe, explore and summarize analyses for communication to appropriate parties
Responsible for completing the analysis process to determine best course of action for each inquiry/problem
Review reports and data for pattern identification, special cause variation identification, trend analysis, or other techniques and provide management level summaries that explain key findings
Collaborate with team members on technical specifications and coding tactics
Assist in quality dashboard development and reporting using Power BI and other visual data tools
Gathers and understands requirements for analytic requests
Perform any other job duties as assigned
Education and Experience:
Bachelor of Science/Arts degree in Management Information Systems (MIS), computer science or related field or equivalent work experience is required
Minimum of two (2) year experience of HEDIS or similar quality healthcare performance metrics experience is required.
2 years Prior programming experience (i.e. SQL, SAS, Python or DAX) is required
Health care delivery and/or payer experience is preferred
Clinical experience is preferred
Competencies, Knowledge and Skills:
Proficient with Microsoft Office Suite
Proficient in minimum one of the programming skills (i.e., SAS, SQL, or DAX) required
Analytic skills for solving multi-dimensional business questions
Graphic development & presentation skills
Exposure to statistical concepts preferred
Critical listening & thinking skills
Effective verbal and written communication skills
Problem Solving skills
Knowledge of managed care and health care data coding
Ability to work with IT teams, familiarity with MDS and data architecture
Licensure and Certification:
None
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$62,700.00 - $100,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business
This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#LI-GB1
$62.7k-100.4k yearly 2d ago
Media Relations Specialist III (Pacific Time Zone)
Caresource 4.9
Caresource job in Dayton, OH
The Media Relations Specialist III is responsible for maximizing earned media opportunities in both traditional news and across a variety of platforms, tracking the benefits of these efforts to drive awareness and business goals.
Essential Functions:
Responsible for identifying new story opportunities to position CareSource with media outlets and build brand awareness with target audiences
Develop and manage content for media and external audiences, including news stories, news releases and other communications
Manage agencies in markets to support company initiatives
Respond to media inquiries in a timely and appropriate manner
Provide support during crisis situations with strategic communications
Monitor daily local, regional and national news coverage about CareSource, health care and related issues
Manage ongoing earned media intelligence platforms and develops quarterly reports
Support social media strategy
Responsible for promoting CareSource locally in all markets and nationally including developing award entries, coordinating media events and providing support to company spokespeople/ presenters
Develop and maintain relationships with key internal stakeholders, including executives, to ensure successful collaboration
Responsible for ensuring all external materials are consistent with brand positioning, established guidelines
Serve as a liaison with key departments to provide effective communication strategy
Maintain a leadership role on project teams
Perform any other job duties as requested
Education and Experience:
Bachelor's degree or equivalent in Communications, Public Relations, Journalism, or related field or equivalent work experience is required
Minimum of five (5) years of experience in media relations is required; healthcare communications experience is preferred
Previous professional writing experience is preferred as demonstrated by portfolio
Competencies, Knowledge and Skills:
Intermediate proficiency level with Microsoft Office
Intermediate proficiency level with visual software programs, such as PowerPoint or other related software program is required
Ability to communicate effectively through oral and written communications
Ability to articulate thoughts with all levels of management and in pressure intense situations
Ability to handle sensitive and confidential matters with discretion.
Effective decision making and problem resolution skills
Strong critical listening and thinking skills
Advanced writing and editing skills
Experienced technical writing skills preferred
Ability to work on and meet tight deadlines
Licensure and Certification:
None
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
May require minimal travel
Compensation Range:
$62,700.00 - $100,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business
This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#LI-RW1
$62.7k-100.4k yearly 4d ago
instED Mobile Health Coordinator - Pacific Standard Time ONLY
Caresource 4.9
Caresource job in Portland, OR or remote
Commonwealth Care Alliance (CCA) is a nonprofit, mission-driven health plan and care delivery organization designed for individuals with the most significant needs. As an affiliate of CareSource, a nationally recognized nonprofit managed care organization with over 2 million members across multiple states, CCA serves individuals enrolled in Medicaid and Medicare in Massachusetts through the Senior Care Options and One Care programs and its care delivery enterprises. CCA is dedicated to delivering comprehensive, integrated, and person-centered care, powered by its unique model of uncommon care, which yields improved quality outcomes and lower costs of care.
Job Summary:
inst ED provides patient-centered, high-quality acute care in place to adults with complex medical needs. Reporting to the Manager, Network Delivery, the inst ED Mobile Health Coordinator (MHC) is the first point of contact for patients who are seeking an inst ED visit. The Mobile Health Coordinator warmly greets all callers and completes a thorough and accurate intake for callers requesting a referral for an inst ED visit. The MHC assigns the visit to one of inst ED's paramedic partners based on geography and availability and monitors the physician assignment algorithm. In addition, the MHC monitors visit progression to ensure timely service delivery. Finally, the MHC assists the nursing team with non-clinical administrative support and serves as the main point of contact for paramedic partner dispatchers, paramedics, and the inst ED Virtual Medical Control (VMC) team for all non-clinical issues.
Essential Functions:
Answer incoming phone calls in a timely manner using a cloud-based platform.
Collect accurate patient information and document in the inst ED NOW platform and Athena medical record to process an inst ED referral.
Collect, review, and accept written consent from patients, upload consents from paramedics.
Verify patient eligibility using inst ED NOW, Athena, or external payor portals.
Collect payment(s) from patients (e.g., copay, co-insurance).
Assign visits to one of inst ED's ambulance partners based on geography and availability; collaborate with nursing staff to prioritize high acuity patients.
Communicate with the dispatchers from the ambulance partners to facilitate throughput of inst ED visits; convey clinical concerns/questions to the nursing team.
Maintain awareness of all ambulance partner vehicle's status and location.
Call patients if mobile health providers are unable to reach patients with an updated ETA; escalate to the nursing team when patients cannot be reached via phone.
Make recommendations to improve the inst ED NOW platform.
Monitor that VMC providers are checked in and out of inst ED NOW in a timely manner and outreach to them if this does not occur.
Monitor VMC auto-assignments and manually re-assign if needed when a VMC provider is nearing the end of shift and cannot complete a visit.
Complete an end of shift report before logging off at the end of a shift.
Ensure that mobile health providers have completed all documentation by the end of their shift and outreach to the paramedic partner when there is outstanding documentation.
Perform any other job related duties as requested.
Education and Experience:
High School or GED required
Associates degree preferred
Five (5) years professional work experience in a healthcare setting with at least one (1) year of remote work experience required
Customer service experience via phone communications, preferably in a health care call center setting interacting with patients required
Process improvement experience required
Experience working closely with colleagues at all levels of a company including front-line staff to senior leaders required
Medical assistant, or other related experience in an urgent care, emergency or home care setting preferred
Administrative support to clinicians in healthcare setting preferred
911 Telecommunicator or Emergency Medical Dispatcher Certification preferred
Mobile integrated health experience preferred
Competencies, Knowledge and Skills:
Ability to communicate effectively without judgment to a diverse patient population while demonstrating empathy
Highly adaptable to frequent workflow changes in a fast-paced environment
Willing to learn and utilize several different software applications (e.g., proprietary inst ED NOW platform, Teams, etc.)
Proficient with Microsoft Outlook
Superb verbal communication skills and strong written communication skills
Computer and phone system proficiency (e.g., Ring Central or other cloud communications platform)
Power BI or other business intelligence software knowledge preferred
Proficient in Excel preferred
Process improvement training (e.g., lean, six sigma, etc.) preferred
Medical terminology preferred
Athena (electronic medical record) knowledge preferred
Bilingual (Spanish), bicultural preferred
Licensure and Certification:
None
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Must be willing to work weekends, evenings, and holidays
Travel is not typically required
Compensation Range:
$41,200.00 - $66,000.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Hourly
Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business
This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
$41.2k-66k yearly 2d ago
Medicare Sales Representative - Base Salary + Commission Opportunities (MustReside in Ohio)
Caresource 4.9
Caresource job in Athens, OH
Are you ready to make a meaningful impact in the lives of Medicare beneficiaries? At CareSource, we're looking for passionate individuals to join our team as a Medicare Sales Representative II. This is more than just a job; it's an opportunity to connect with your community, educate seniors about their healthcare options, and help them navigate the Medicare landscape.
Why CareSource?
Competitive Compensation:Enjoy a guaranteed base salary along with generous commissions based on your sales performance. Your hard work pays off!
Sign-On Bonus:We value your expertise and offer a sign-on bonus to welcome you to our team.
Qualified Leads:Benefit from a steady stream of qualified leads to help you succeed in your role.
Flexible Work Environment:This mobile position allows you to travel within your assigned territory, attend community events, and engage with clients on your schedule.
What You'll Do:
Empower the Community:Develop educational and enrollment opportunities with local agencies, senior resources, and community organizations to ensure seniors have access to the best Medicare Advantage products.
Engage & Educate:Conduct presentations and marketing activities that inform and inspire, all while adhering to state and federal regulations.
Build Relationships:Foster strategic partnerships with key stakeholders to drive enrollment and sales success.
Be a Resource:Serve as a subject matter expert on CareSource's Medicare Advantage offerings, guiding beneficiaries through their choices during the enrollment process.
Achieve Goals:Meet and exceed monthly sales targets while maintaining a focus on customer satisfaction and compliance.
What We're Looking For:
Education:High School diploma or GED required; an Associate's Degree in business, healthcare, or a related field is preferred.
Experience:At least one year of experience in Medicare or Medicaid sales, or other commercial insurance sales is required.
Skills:Proficiency in CRM systems, Microsoft Office Suite, and excellent communication skills are essential. Bilingual candidates are preferred!
Licensure & Certification:
Current, unrestricted Insurance License in Accident and Health within your assigned territory is required, or the ability to obtain it within 30 days of hire.
Medicare Fraud, Waste, and Abuse (MFWA) certification required within 30 days of hire.
Working Conditions:
This role requires regular travel to various locations within your territory, and you should be comfortable working flexible hours, including evenings and weekends as needed.
At CareSource, we are committed to creating a diverse and inclusive workplace. We provide reasonable accommodations to qualified individuals with disabilities or medical conditions, ensuring everyone has the opportunity to thrive.
Ready to Make a Difference?If you're passionate about helping others and want to be part of a team that values your contributions, we'd love to hear from you! Apply today and take the first step toward a rewarding career with CareSource.
Compensation Range:
$47,400.00 - $76,000.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business
This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#LI-ST1
$47.4k-76k yearly 18h ago
Women and Children's Health Regional Coordinator- Appalachian Counties Ohio
Caresource 4.9
Caresource job in Dayton, OH
The Women & Children's Health Regional Coordinator will be responsible to identify, coordinate and support Medicaid School Programs, Schools, and School Based Health Centers to ensure CareSource children are receiving care needed.
Essential Functions:
Develop and enhance CareSource relationships with MSP Schools, all other Schools, and School-Based Health Centers (SBHCs) with the goal of providing accessible quality preventive and primary care services to school-aged CareSource members.
Develop partnerships with kindergarten readiness programs including Head Start, preschool programs and those community based organizations that support early childhood education.
Assist MSP schools, all other Schools and SBHCs in identifying gaps in care and expected outcomes in the health status of targeted populations.
Enhance effectiveness of MSP Schools, all other Schools and SBHCs' population health through a variety of member health outcome and quality improvement techniques
Strategize with MSP Schools, all other Schools and SBHCs to develop and enhance the practice's engagement strategies for individual members..
Attend school district meetings as appropriate including staff professional development programs and PTA meetings as requested.
Ability to collaborate and coordinate health programs with schools and mobile health programs and identify new school support partners within the region assigned.
Present to school staff and leadership regarding school-based health resources, member benefits and mobile health partner information to close gaps in care.
Collaborate with community- based organizations that support school districts within the assigned region.
Link MSP Schools and SBHCs to internal resources to ensure understanding of all operational and billing processes.
Participate in driving and achieving established HEDIS initiatives as assigned.
Support local presence by participating in community outreach programs/health events, school events, parent engagement programs, and other opportunities in the community.
Identify and ensure members receive appropriate information regarding benefits and services upon notification of pregnancy (information regarding benefits for maternal, infants and children's care including EPSDT).
Assist in education of members regarding available benefits and providers, plan services available, according to established policies and procedures
Telephonically outreach and engage members to identify needs and coordinate linkage to most appropriate resources and services(WIC, and Community programs)
Assist members' progression through the stages of behavioral change, changing family dynamics and health care needs.
Ability to empathize, motivate, and encourage people toward healthy changes, regardless of culture, religion, or economic background
Refer members to care coordination to assist member in forming solutions for identified problem(s) area and define and determine realistic goals with member.
Collaborate with internal School-based Health Administrator and Community Based Organizations to implement strategies and initiatives to improve health outcomes.
Participate and collaborate to utilize community events and programs to support and improve health outcomes for school age children
Assist in development and processing Strategic Sourcing request and process.
Assist with process development, tracking of referrals, interventions, and outcomes
Ability to communicate and interact with individuals at varying skill levels, educational and cultural backgrounds
Foster and develop an environment of individual responsibility.
Willingness to teach, learn and be open to new and innovative ways of delivering lifestyle prevention services.
Demonstrates a commitment to continuing professional development
May act as a resource for others within the department
Work closely with a members' assigned case manager to coordinate care and programs
May provide administration of onsite wellness activities
Perform any other job-related instructions, as requested
Education and Experience:
Associate degree or equivalent years of experience within healthcare and/or school /children's health is required
Minimum of two (2) years of experience in healthcare, managed care and /or maternal-child health is required
Competencies, Knowledge and Skills:
Ability to manage and meet workloads and deadlines
Able to provide timely feedback to CareSource team members and business partners and prioritize provider and member engagement initiatives
Intermediate proficiency level with Microsoft Office, Outlook, Word, and Excel
Ability to communicate effectively with diverse population
Ability to multi-task and work independently within a team environment
Ability to collaborate with other internal team members to optimize birth and health outcomes for school-aged children
Knowledge of community and state support and advocacy resources for population served
Familiarity of state and federal healthcare regulations and environment
Critical listening and thinking skills and willingness to be flexible
Decision making and problem-solving skills
Proper grammar use and phone etiquette
Strong organizational and time management skills
Ability to work within autonomous role, adapting and modifying plan of care of member as required
Ability to work within web-based applications to manage consumer data
Licensure and Certification:
Employment in this position is conditional pending successful clearance of a driver's license record check. If the driver's license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in the position will be terminated
Employment is conditional pending successful clearance of a criminal background check
To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 - March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer
Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members and may refer members to other CareSource resources
WAH and/or Office Location
May require travel up to 50% of time worked
Compensation Range:
$47,400.00 - $76,000.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Hourly
Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business
This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#LI-TS1
$47.4k-76k yearly 4d ago
Community Health Worker - Ohio Mobile
Caresource 4.9
Caresource job in Toledo, OH
The Community Health Worker participates as a member of the inter-disciplinary care team (ICT) to coordinate care for members.
Essential Functions:
Engage with the member in a variety of settings to establish an effective, professional relationship. Settings for engagement include but are not limited to; hospital, provider office, community agency, member's home, telephonic or electronic communication
Accompany members to appointments and other social service encounters when necessary
Coordinate logistics to support members' care plan goals and interventions - reminders, transportation, and childcare arrangements
Verify eligibility, previous enrollment history, demographics and current health status of each member
Contribute to assessments by gathering information from the member, family, providers and other stakeholders
Contribute to the development and implementation of the individualized care plan based on member's needs and preferences, reporting information to the Case Manager
Assist with identifying and managing barriers to achievement of care plan goals
Assist with empowering the member to manage and improve their health, wellness, safety, adaptation, and self-care through effective care coordination
Assist with the provision of health education and wellness materials as directed by the Case Manager(s) or Team Lead
Evaluate member satisfaction through open communication and monitoring of concerns or issues
Maintain appropriate documentation within protocols and guidelines of the Care Management program
Looks for ways to improve the process to make the members' experience with CareSource easier and shares with leadership to make it a standard, repeatable process
Regular travel to conduct member, provider and community based visits as needed to ensure effective administration of the program
Perform any other job duties as requested
Education and Experience:
High School Diploma or General Education Diploma (GED), is required
Minimum of two (2) years of experience in either volunteer or paid position working in community settings with at risk populations providing coordination of services is preferred
Competencies, Knowledge and Skills:
Proficient with Microsoft Office, including Outlook, Word and Excel
Sensitivity to and experience working within different cultures
Good interpersonal skills
Ability to work independently and within a team environment
Ability to identify problems and opportunities and communicate to management
Developing knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices
Demonstrate compassion, support and collaboration with members and families
Self-motivated and inquisitive
Comfort with asking pertinent questions
Ability to work in a fast-paced environment
Ability to demonstrate and promote ethical conduct
Ability to develop positive relationships with all stakeholders
Awareness of community & state support resources
Organized , detail-oriented and conflict resolution skills
Ability to keep composure and professionalism during times of high emotional stress
Ability to maintain confidentiality and act in the company's best interest
Proven track record of demonstrating empathy and compassion for individuals
Proven track record for improving processes to make things easier for those you have served
Licensure and Certification:
Community Health Worker Certification, or equivalent approved training program, is preferred
Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver's license record check and verified insurance. If the driver's license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in the position will be terminated.
To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 - March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.
Working Conditions:
This is a mobile position, meaning that regular travel to different work locations, including homes, offices or other public settings, is essential. Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time.
Must reside in the same territory they are assigned to work in; exceptions may be considered, due to business need
May be required to travel greater than 50% of time to perform work duties.
Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer
Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members
Compensation Range:
$35,900.00 - $57,300.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Hourly
Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business
This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#LI-JS1
$35.9k-57.3k yearly 4d ago
Program Integrity Data Scientist II
Caresource 4.9
Caresource job in Dayton, OH
The Program Integrity Data Scientist II is responsible for developing, implementing, managing, and deploying in-depth analyses that meet the information needs associated with payment accuracy, anomaly detection, and Fraud, Waste, and Abuse (FWA).
Essential Functions:
Build concepts as algorithms that identify claims for pre- or post-pay intervention based on probability of fraud, waste, and abuse. Algorithms are implemented into production workflows for action: medical record request and audit, downcode adjustment, denial and remittance communication, etc.
Analyze and quantify claim payment issues and provide recommendations to mitigate identified program integrity risks.
Identify trends and patterns using standard corporate, processes, tools, reports and databases as well as leveraging other processes and data sources.
Conduct outcome analyses to determine impact and effectiveness of corporate program and payment integrity initiatives.
Collaborate on the examination and explanation of complex data relationships to answer questions identified either within the department or by other departments as it relates to payment accuracy, anomaly detection, and FWA.
Monitoring of and providing explanation of anomalies related to trends associated with the potential for Fraud Waste and Abuse across the corporate enterprise.
Collaborate with the Legal Department, generating data and analyses to support Legal proceedings.
Develop hypothesis tests and extrapolations on statistically valid samples to establish outlier behavior patterns and potential recoupment.
Create, maintain, and communicate an analytical plan for each project.
Mine and analyze large structured and unstructured datasets.
Employ wide range of data sources to develop algorithms for predicting risk and understanding drivers, detecting outliers, etc.
Develop visualizations that demonstrate the efficacy of developed algorithms.
Provide statistical validation and analysis of outcomes associated with clinical programs and interventions.
Collaborate with other teams to integrate with existing solutions.
Communicate results and ideas to key stakeholders.
Prepare code for operationalization of end-to-end model pipeline and deliverable for business consumption.
Perform any other job related duties as requested.
Education and Experience:
Bachelor's degree in Data Science, Mathematics, Statistics, Engineering, Computer Science, or a related field required
Equivalent years of relevant work experience may be accepted in lieu of required education
Three (3) years data analysis and/or analytic programming required
Experience with cloud services (such as Azure, AWS or GCP) and modern data stack (such as Databricks or Snowflakes) preferred
Healthcare experience required
Competencies, Knowledge and Skills:
Proficient in SQL and at least one of the following programming languages: Python / R / RAT STAT
Familiarity with SAS is preferred
Preferred beginner level of knowledge of developing reports or dashboards in Power BI or other business intelligence applications
Ability to perform advanced statistical analyses and techniques including t-tests, ANOVAs, z-tests, statistical extrapolations, non-parametric significance testing, and sampling methodologies
Working knowledge of predictive modeling and machine learning algorithms such as generalized linear models, non-linear supervised learning models, clustering, decision trees, dimensionality reduction and natural language processing
Proficient in feature engineering techniques and exploratory data analysis
Familiarity with optimization techniques and artificial intelligence methods
Ability to analyze large quantities of information and identify patterns, irregularities, and deficiencies
Knowledge of healthcare coding and billing processes, including CPT4, HCPCS, ICD-9, DRG and Revenue Codes preferred
Proficient with MS office (Excel, PowerPoint, Word, Access)
Demonstrated critical thinking, verbal communication, presentation and written communication skills
Ability to work independently and within a cross-functional team environment
Licensure and Certification:Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Up to 15% (occasional) travel to attend meetings, trainings, and conferences may be required
Compensation Range:
$83,000.00 - $132,800.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business
This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#LI-GB1
$83k-132.8k yearly 4d ago
EDI Technical Product Manager
Caresource 4.9
Caresource job in Dayton, OH
The EDI Technical Product Manager serves as the strategic and technical owner of CareSource's EDI platform, responsible for driving the vision, roadmap, and execution of enterprise data exchange capabilities. This role combines a deep understanding of healthcare EDI standards with strong product management and technical skills to deliver scalable, reliable, and regulatory-compliant integration solutions. The EDI Technical Product Manager partners with engineering, architecture, operations, and business stakeholders to ensure EDI products support organizational objectives, reduce friction for trading partners, and improve end-to-end data quality.
Essential Functions:
Define and evolve the EDI product vision, strategy, and long-term roadmap in alignment with enterprise architecture, regulatory mandates, and CareSource's operational priorities.
Create business cases, success metrics, and ROI analyses to guide prioritization and investment decisions.
Stay current on industry trends, CMS/state requirements, and interoperability standards (X12, APIs, FHIR) to shape the future-state EDI landscape.
Translate complex business, regulatory, and integration requirements into clear, actionable user stories and technical specifications for engineering teams.
Ensuring requirements encompass data mapping, validation business rules, error handling flows, and integration points across downstream systems.
Collaborate closely with architecture, engineering, QA, and DevOps to guide solution design, ensure technical feasibility, and support high-quality deployment.
Own and prioritize the EDI product backlog based on technical dependencies, stakeholder value, operational impact, and compliance needs.
Drive sprint planning, feature readiness, and release coordination to support predictable and transparent delivery.
Identify and remove impediments that impact engineering throughput or trading partner readiness.
Act as a bridge between technical teams, trading partners, clearing houses, and internal business units to ensure alignment and clarity of expectations.
Lead discovery sessions, refinement cycles, data exchange walkthroughs, and post-implementation assessments.
Advocate for partner usability and operational efficiency through system improvements, automation, and enhanced monitoring capabilities.
Analyze transaction performance, defect trends, operational SLAs, and platform telemetry to identify risks, bottlenecks, and optimization opportunities.
Define and track KPIs/OKRs such as transaction throughput, first-pass acceptance rate, error volume, partner onboarding speed, and system reliability.
Collaborate with engineering to drive continuous improvement in observability, error reconciliation, and data integrity.
Establish and maintain comprehensive product documentation, functional requirements, user guides, and integration specifications.
Contribute to technical standards, EDI governance frameworks, and best practices for onboarding, testing, and release coordination.
Ensure solutions comply with HIPAA, state Medicaid requirements, data privacy standards, and CareSource security guidelines.
Perform any other job related duties as requested.
Education and Experience:
Bachelor's degree in computer science or related field required
Equivalent years of relevant work experience may be accepted in lieu of required education
Five (5) years of experience in product management or related field required
Competencies, Knowledge and Skills:
Strong understanding of EDI technologies and integration platforms
Familiarity with Agile methodologies and product development life cycles
Skilled in software development or engineering
Understanding of the Healthcare industry and ecosystem including future direction. In-depth knowledge of interoperability standards relevant to the industry
Strong verbal and written communication skills are essential for articulating product vision and collaborating with stakeholders
Strong analytical and problem-solving skills to assess performance and identify areas for improvement
Ability to adapt to rapidly changing technologies and market conditions
A mindset geared toward innovation, continuously seeking new ways to enhance capabilities and interoperability
Knowledge of AI technologies, machine learning models, and ethical considerations in AI deployment
Licensure and Certification:
Certifications in core technical systems such as Edifecs, Facets, Cloud, AI, or other similar enterprise systems that CareSource invests in are preferred
Certifications in Agile, SAFE, or in the Business or Product Owner role are preferred
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Travel is not typically required
Compensation Range:
$94,100.00 - $164,800.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business
This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#LI-GM1
$94.1k-164.8k yearly 18h ago
Clinical Policy Specialist
Caresource 4.9
Caresource job in Dayton, OH
The Clinical Policy Specialist I provides clinical policy support to both new and established lines of business (LOB) through managing state submissions, submitting Communication Request Forms, tracking processes, and ensuring clinical policy compliance.
Essential Functions:
Assist Clinical Policy Project Specialist to execute, monitor and support new lines of business throughout the entire clinical policy project lifecycle.
Audit, monitor and prepare clinical policies for NQCA, state, and internal audits
Develop, implement, configure, and maintain decision trees, workflows, documentation and monitoring protocols to operationalize clinical policies and criteria in a timely manner
Participate in department initiatives and projects including implementation of new document management systems
Support the development and maintenance of enterprise Clinical Policy programs (i.e., policy assessments, department newsletter, network notification communications)
Collaborate with interdisciplinary team members to achieve team goals
Participate in risk assessment and continuous improvement activities, as needed
Follow Workfront procedures to coordinate and implement changes ensuring regulatory, compliance, and business goals are met
Ensure timely submission, accurate documentation, and tracking of all Communication Request Forms and network notifications for clinical policies to be published on external websites
Monitor the CareSource public website to ensure policies are accurately published and accessible
Document and track state submissions and approvals, keeping consistent communication with Clinical Policy team, leadership, and regulatory as necessary.
Track and trend clinical policy metrics (i.e., CRF, archives, revisions) reported monthly, quarterly, end of year, and as needed
Assist with Policy Tech functions to streamline policies through the entire end-to-end process
Support the operational processes of the Clinical Policy Governance Committee (CPGC)
Create agendas, document, and store minutes and pertinent records for all assigned team meetings as necessary
Maintain and update job related internal policies and procedures applicable to Clinical Policy process and workflows
Provide coverage for both Policy Coordinator and Policy Project Specialist when needed
Perform any other job duties as requested
Education and Experience:
Bachelor's degree or equivalent years of relevant work experience is required
Health plan experience is preferred
SharePoint management experience preferred
Minimum of two (2) years of healthcare policy experience is preferred
Documentation Management system experience is preferred
Competencies, Knowledge and Skills:
Computer skills/proficiency level with Microsoft Word, Excel, search engines, and bibliographic software
Detail-oriented and critical thinker
Proficient in documentation management systems
Proficient in SharePoint
Proficient in creating and delivering effective PowerPoint presentations
Knowledge of medical terminology, pharmacy claims processing, and healthcare administration
Ability to interpret clinical information
Excellent verbal and written communications skills
Presentation and decision-making skills
Excellent organization and tracking skills
Strong problem-solving skills
Ability to communicate effectively with employees at all levels of the organization.
Ability to work autonomously and in a team environment
Ability to handle multiple priorities/projects simultaneously
Licensure and Certification:
Basic Six Sigma or Lean certification preferred
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Occasional travel may be required to fulfill job duties
Compensation Range:
$54,500.00 - $87,300.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business
This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#LI-JM1
$54.5k-87.3k yearly 4d ago
Pharmacy Resident - Managed Care
Medimpact Healthcare Systems 4.8
Remote job
Exemption Status:United States of America (Non-Exempt)$19.11 - $24.65 - $30.19
“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”
This position is not eligible for Sponsorship.
MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!
Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.
At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!
Job DescriptionMedImpact's Managed Care Pharmacy Residency Program is a one-year program that develops future managed care leaders by building a strong foundation of knowledge in both clinical and managed care principles. By working across multiple teams serving all lines of business, the diverse experience gained will amply prepare the resident for a career in managed care pharmacy.The Managed Care Pharmacy Resident provides support to the Government Programs and Services (GPS) team and other departments through managed care learning experiences (rotations) and longitudinal projects. The rotations/projects will include a breadth of disciplines including clinical operations, utilization and formulary management, clinical account services, quality assurance and improvement, government program management, analytics and research.Essential Duties and Responsibilities include the following. Other duties may be assigned.
Perform cost savings and member impact analyses after learning benefit design and utilization management strategies.
Contribute to clinical quality programs, such as Drug Utilization Review (DUR), Transitions of Care and other initiatives to improve HEDIS and CMS Star Ratings.
Support clients by developing and implementing quality and cost savings initiatives and managing custom formularies across all lines of business.
Participate in the management of government programs to evaluate and facilitate regulatory programs.
Perform quality program oversight and develop quality improvement initiatives while supporting oversight audits.
Evaluate prior authorization requests and understand the regulatory requirements governing prior authorization reviews, which includes four hours of weekly staffing.
Assist in P&T material preparation and weekly drug updates. Present at MedImpact P&T Committee meetings.
Develop presentation skills to lead meetings while learning to manage projects and navigate corporate complexities.
Conduct a longitudinal research project designed for presentation at AMCP Annual Meeting.
Education and/or Experience
PharmD from an ACPE-accredited school of pharmacy
Minimum GPA of 3.0
Managed Care experience preferred
Certificates, Licenses, Registrations
Must obtain Registered Pharmacist license in state of residence and Kentucky by October 1st of the program year.
Other Skills and Abilities
Strong analytical and problem-solving capabilities
Excellent communication and presentation skills
Ability to work independently and as part of a team
Knowledge of PBM operations, drug formulary systems, and healthcare regulations
Reasoning Ability
Ability to deal with nonverbal symbolism (formulas, scientific equations, graphs, musical notes, etc.,) in its most difficult phases. Ability to deal with a variety of abstract and concrete variables.
Ability to define problems, collect data, establish facts, and draw valid conclusions.
Language Skills - Choose up to 1 from each drop-down list.
Ability to effectively present information to top management, public groups, and/or boards of directors.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Competencies To perform the job successfully, an individual should demonstrate the following competencies:
Composure
Decision Quality
Organizational Agility
Problem Solving
Customer Focus
Drive for Results
Peer Relations
Time Management
Dealing with Ambiguity
Learning on the Fly
Political Savvy
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic).
Working Hours
This is an exempt level position requiring the incumbent to work the hours required to fully accomplish job responsibilities and reasonable meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required. Work hours may be changed from time to time to meet the needs of the business. Typical core business hours are Monday through Friday from 8:00am to 5:00pm.
Travel
This position requires domestic travel of up to 25% of the time.
Please include Letter of Intent AND Curriculum Vitae (CV) in Workday along with submission of application.
Official transcript must be emailed directly from pharmacy school to ******************************.
Three letters of recommendation must be emailed directly from letter writers to ******************************.
The Perks:
Medical / Dental / Vision / Wellness Programs
Paid Time Off / Company Paid Holidays
Incentive Compensation
401K with Company match
Life and Disability Insurance
Tuition Reimbursement
Employee Referral Bonus
To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to *************************
MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego,
California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.
Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/ADA:
To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Disclaimer:
The above
statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
works with internal and external customers as well as program leadership to ensure all are kept up-to-date on the accuracy and timeliness of reimbursements according to contract specific requirements and for problem solving as needed. The senior expense coordinator position provides ongoing Costpoint assistance to program leaders, supervisors, and employees as needed to ensure timely and accurate expense reimbursement.
Tracks Employee Expense Reports as they move through the Expense Report System.
Identifies and resolves problems and inconsistencies and suggests appropriate corrective procedures.
Ensures expenses are charged to correct accounts, project codes, and organizations by reviewing voucher edit report.
Follows up with employees on aging expense reports in draft status, as well as with managers for expense reports waiting for approval.
Works closely with billing to resolve expense reimbursement discrepancies, errors and/or questions.
Assists employees and managers with making corrections to expense reports as needed.
Assists with business travel account reconciliations to ensure all company paid expenses are accounted for in the expense report system.
Reviews receipts and travel documentation for required information and accuracy and performs the function of recording attachments in Deltek Time & Expense.
Collaborates with travel team members and regional staff regarding expense reporting and required documentation.
Maintains up-to-date knowledge of the Joint Federal Travel Regulations and contract requirements and allowability of expenses.
Maintains tracking spreadsheet & ensures all notes are up to date and action items are completed.
Assists with creating expense reimbursement training documents and policy review.
Participates in monthly live expense reimbursement employee training sessions.
Supports ongoing projects or other duties as needed.
The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.
Other Job Requirements
Responsibilities
2+ years of experience in Federal Joint Travel expense reimbursement reporting OR 1+ years of experience with expense reporting and 1+ years of experience in accounts payable invoicing coding in a Federal Regulated environment.
Direct experience in General Services Administration (GSA) and Joint Travel Regulations (JTR).
Proficiency in Excel.
Working knowledge of Ten-Key by Touch.
Detail Oriented.
General Job Information
Title
Senior Expense Reimbursement Coordinator, Federal (Expense Reports, Costpoint Experience Preferred)) - Remote
Grade
21
Work Experience - Required
Accounting, Accounts Payable
Work Experience - Preferred
Education - Required
Education - Preferred
Associate
License and Certifications - Required
License and Certifications - Preferred
Salary Range
Salary Minimum:
$45,655
Salary Maximum:
$68,485
This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
$45.7k-68.5k yearly Auto-Apply 7d ago
Manager, Cost Reporting
Caresource 4.9
Caresource job in Dayton, OH
The Manager, Finance - Cost Reporting is responsible for managing the cost reporting processes within the finance department. This role involves ensuring accuracy and completeness of financial data, preparing detailed cost reports, and analyzing financial information to assist in strategic planning and decision making. They will collaborate with various departments to gather necessary data, maintain and improve internal reporting systems, and ensure compliance with company policies and regulatory standards.
Essential Functions:
Assist and lead in the preparation and analysis of detailed cost reports, ensuring accuracy and completeness.
Analyze cost report data to identify trends, discrepancies, and opportunities for improvement in reimbursement outcomes.
Support the implementation of internal reporting systems to enhance data accuracy and reporting efficiency.
Ensure compliance with company policies and regulatory standards and guidelines in all financial reporting.
Participate in process improvement initiatives to streamline cost reporting procedures.
Communicate complex financial data clearly and effectively to stakeholders with varying levels of financial expertise.
Assist in implementing strategic plans set forth by senior management, with a focus on cost reporting functions.
Prepare management reports and presentations summarizing cost report findings and reimbursement impacts.
Perform any other job related duties as requested.
Education and Experience:
Bachelor's degree in Finance, Accounting, or a related field required
Master of Business Administration (MBA) preferred
Equivalent years of relevant work experience may be accepted in lieu of required education
Five (5) years healthcare finance or reimbursement with significant exposure to Medicaid cost reporting required
Management experience preferred
Competencies, Knowledge and Skills:
Strong verbal and written communication skills
Familiar with variety of accounting and finance concepts, practices and procedures
Strong knowledge of Medicaid cost reporting principles, state and federal regulations, and healthcare reimbursement methodologies
Microsoft Office expert (particularly Excel)
Proficient in Databricks, Spark SQL, Databricks Workflows, Transact-SQL, Python
Familiar with SQL, ETL or other programming concepts
Highly self-motivated
Ability to interact with all levels of management
Critical thinking and listening skills
Ability to work independently and as a member of a team
Demonstrates decision making and analytical/problem solving skills to perform a variety of complicated tasks
Familiarity with the healthcare field and basic medical terminology
Demonstrates interpersonal and relationship building skills
Ability to lead and direct the work of others including the development, motivation and rewarding of staff
Excellent organizational skills and attention to detail
Ability to contribute to climate finance research projects, with strong ability to synthesis findings, create detailed reports, and communicate insights effectively to diverse stakeholders
Excellent time management skills with ability to meet deadlines without being reminded
Proficient in Microsoft Power BI, SSIS, SSRS
Licensure and Certification:
Certified Public Accountant (CPA), Certified Management Accountant (CMA), Certified Healthcare Financial Professional (CHFP), or related certification preferred
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Ability to travel as required by the needs of the department.
Compensation Range:
$94,100.00 - $164,800.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business
This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#LI-EM1
$94.1k-164.8k yearly 2d ago
instED Virtual Medical Control Physician (Part Time)
Caresource 4.9
Caresource job in Dayton, OH
Reporting to the Chief Medical Officer of inst ED, the Virtual Medical Control (VMC) Physician provides medical decision making, including all elements of diagnostics, treatment, and disposition, to patients seen by inst ED's Mobile Integrated Healthcare service. The VMC serves as the clinician of record, prescribes short-term treatments, documents the encounter in inst ED's medical record, and relays any essential follow-up needs to the care team via the inst ED Clinical Resource Center (CRC) team.
Essential Functions:
Provide patient-centered, high-quality acute care in place to individuals with complex medical needs per clinical protocols.
Work closely with mobile integrated healthcare clinicians (paramedics and EMTs) and other inst ED team members.
Participate in biannual performance reviews.
Participate in scheduled operational or clinical meetings, based on schedule availability, to remain up to date on programmatic and company activities and implications for clinical practice.
Collaborate with other VMCs, and with CRC team members as needed, primarily around managing visit volumes and clinical questions.
Provide clinical and operational feedback to management team to improve care delivery.
Collaborate with referring Care Partners and Primary Care Providers.
Document visit within the EMR in a complete, accurate, and timely manner. Documentation should include relevant data, medical decision making, and follow-up needs.
Attend required onboarding, training, and online compliance education courses.
Protect patient confidentiality.
Provide clinical care to patients via various telehealth technologies (telephonic, video, direct messaging).
Maintain necessary professional licenses and credentials needed for independent practice.
Obtain licensure in additional states as inst ED grows.
Perform any other job related duties as requested.
Education and Experience:
Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) required
Three (3) years of experience as an attending physician in acute care and/or inpatient medicine required
Experience caring for medically and socially complex patients required
Experience working collaboratively with a variety of professionals required
Experience providing non-face-to-face care, especially in telephone or virtual care required
Adaptability to change in systems and workflows required
Innovative, team-player, and expert communicator required
Competencies, Knowledge and Skills:
Ability to virtually/remotely assess medically complex patients
Ability to provide person-centered, medically and clinically appropriate care options to patients
Willingness to learn best practice in delivering home-based care
Comfort with remote care delivery model and technology
Comfort with shared decision making and patient-centered consideration of risk
Ability to virtually/remotely assess medically complex patients
Ability to work in a team-based care delivery model
Strong written and verbal communication skills
Comfort with Health IT and EHR systems.
Experience working with EMS professionals (paramedics/EMTs) desired
Ability to speak/read/write English fluently
Licensure and Certification:
Active Board Certification in Internal Medicine, Family Medicine, or Emergency Medicine MD/DO required
Current licensure or ability to obtain active licensure in states inst ED is operational required
Current DEA registration required
MA Health Enrollment (if licensed in Massachusetts) required
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Travel is not typically required
Compensation Range:
$195,200.00 - $341,600.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Hourly
Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business
This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
$195.2k-341.6k yearly 2d ago
Team Lead, Operations Application Development (Facets Dev)
Caresource 4.9
Caresource job in Dayton, OH
The Team Lead, Operations Application Development is responsible for the day-to-day activities surrounding the knowledge and insight around development and support of the Operations Application Development team utilizing best practices and ensuring goals and standards align with Operations Technology goals.
Essential Functions:
Guide and direct successful completion of daily tasks.
Prioritize all work, requests and activities. Escalate any area of significant resource contention along with recommendation for resolution.
Track issues and status to ensure proper follow-up, coordination with business area provide solutions.
Update projects that application development is involved with and coordinate any needed changes with next level leader.
Provide management with ticket dashboards. Identify root cause of staff issues and appropriate pro-active resolution to reduce tickets in the future.
Support a professional relationship between key business stakeholders and Operations Technology teams.
Work closely with customers, business partners, project managers, and team members to understand business requirements that drive the analysis and design of quality solutions that are aligned with business and Operations Technology strategies and comply with the organization's architectural standards.
Assist in the team's execution of planned and carryover work.
Develop efficient processes to enable teams to achieve quality/efficient delivery.
Understand Operations Technology needs and evaluate delivery process to drive continuous improvement.
Support business decisions required by technology, development status, problems and issues, project status and success.
Participate in departmental meetings/activities and contribute to a collaborative team environment.
Responsible for onboarding, training, and development of staff.
Perform any other job related duties as requested.
Education and Experience:
Bachelor's degree in Business, Computer Science or a related field required
Equivalent years of relevant work experience may be accepted in lieu of required education
Three (3) years of Application Development experience required
Three (3) years of health plan business or systems solutions experience required
Previous management experience preferred
Three (3) years Facets Development Experience required
Competencies, Knowledge and Skills:
Effective problem-solving capabilities with attention to detail
Technical coaching and mentoring skills
Project planning skills and abilities
Knowledge of technology architecture design and implementation (infrastructure or application development)
Effective technical programming, analysis, and specification skills
Process and/or workflow planning and design skills
Knowledge of Application Development tools and Enterprise Architecture (e.g. TOGAF)
Advanced system configuration skills
Proficient in Microsoft technologies (infrastructure or application development)
Strong knowledge of best practices relative to application development or infrastructure standards
Strong written and verbal communication skills
Effective time management, organization, and prioritization skills
Strong interpersonal skills and high level of professionalism
Ability to prioritize and execute tasks in a fast-paced environment
Licensure and Certification:
Certifications on Microsoft Technology, Certifications on HealthCare, Certifications on Facets preferred
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Travel is not typically required
Compensation Range:
$83,000.00 - $132,800.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business
This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#LI-GB1
$83k-132.8k yearly 4d ago
Family Support Navigator
Magellan Health 4.8
Remote job
This position provides non-clinical, evidence-based peer support services and serves as a member and family advocate. The FSN brings their life experiences and skills to deliver assistance to the family as they explore the goals they would like to achieve and offers interventions to the family to increase engagement and empowerment within a variety of service delivery systems.
Provides peer support to family/caregivers of children with mental health and substance use conditions identified as requiring intensive wellness support and recovery-oriented interventions.
Guides families in creating Wellness Recovery Action Plans (WRAP ) for themselves and their family to recognize strengths and identify wellness self-management and crisis prevention strategies.
Utilizes the 8 dimensions of wellness to help parents/caregivers identify their social determinants of health needs, determine their whole health goals and objectives in order to address their own challenges and those of their child.
Guides and empowers family members to understand and participate in all decisions related to the treatment process, the support plan, service choices, and transitions in care.
Coaches and role-models regarding a parent's perspective and lessons learned from life experience.
Facilitates support and education to families who have questions, concerns or specific needs related to mental health or substance use and their relationship to Magellan and child serving agencies.
Strategically shares their lived experience to inspire hope, empowerment, and positive action.
Performs ongoing interventions to engage families and members in traditional and nontraditional health services and supports, as well as community and social support networks including community-based peer, parent, and family support services.
Facilitates a team approach to member care including with the Magellan care coordination team.
Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes.
Acts as an advocate for family and member`s needs by identifying and addressing gaps in services and supports.
Educates providers, supporting staff, members, and families on resiliency and recovery-oriented principles, practices, strategies, and tools.
Documents all interactions according to company standards.
Maintains professional responsibility to maximize supervision, respond appropriately to personal stressors that impact ability to perform job duties, and recognize crisis situations or risks to the member's safety and respond appropriately.
Travels to meet families within the community.
Other duties as assigned.
The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.
Other Job Requirements
Responsibilities
2+ years' experience working as a family peer specialist.
Peer Specialist certification as required by the state.
CFPS/National Peer Support Credential required within one year of hire.
Must be or have been a parent or caregiver of a child who is or who has in the past received services from a child-serving agency for mental health related issues.
Applicants must be able to draw from their own personal experience of parenting or caregiving for a child or youth with significant mental health or substance use challenges; negotiating services and supports for their child and family; be familiar with key resources for children, youth and families in the community; be able to transcend personal events to provide unconditional support and assistance to families.
Positive attitude that communicates hope and a recovery and resiliency orientation; approachable and empathetic; strong people skills.
Must have a vehicle in good, working condition with the ability to travel within the community regularly.
Working knowledge of Microsoft Office Product Suite.
Ability to make decisions that require significant analysis of solutions, and quick, original, and independent thinking.
Ability to determine appropriate courses of action in complex situations that may not be addressed by existing policies or protocols.
Knowledge of local mental health, substance use, and community systems; wellness strategies, resiliency and recovery principles, practices, and tools, such as system of care, Wellness Recovery Action Plans (WRAP), wraparound process, and community-based peer, family and parent support organizations and services.
Strong interpersonal and organizational skills and effective verbal and written communication skills.
Ability to represent strengths and needs of families and members in clinical settings.
Ability to summarize and document findings and maintain complete and accurate records.
Must be able to work effectively, independently and in a team, and prioritize in a fast-paced environment to meet the demands of the organization.
General Job Information
Title
Family Support Navigator
Grade
19
Work Experience - Required
Lived experience as parent/caregiver of a child with mental health challenges, Peer Specialist
Work Experience - Preferred
Education - Required
Education - Preferred
Associate
License and Certifications - Required
CPRS/CPS/CPSS/CRPS/PRSS, Peer Specialist, State Requirements - Care MgmtCare Mgmt, DL - Driver License, Valid In State - OtherOther
License and Certifications - Preferred
NCPS - National Certified Peer Specialist - Care MgmtCare Mgmt
Salary Range
Salary Minimum:
$37,725
Salary Maximum:
$56,595
This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
$37.7k-56.6k yearly Auto-Apply 60d+ ago
CISC Care Coordinator, Licensed
Magellan Health 4.8
Remote job
Independently coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes. Duties performed are either during face-to-face home visits or facility based depending on the assignment. Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction. Assists with orientation and mentoring of new team members as appropriate. May act as a team lead for non-licensed care coordinators.
Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources.
Conducts in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters.
Communicates and develops the care plan and serves as point of contact to ensure services are rendered appropriately (e.g., during transition to home care, back up plans, community based services).
Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes.
Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs.
Acts as an advocate for members' care needs by identifying and addressing gaps in care.
Performs ongoing monitoring of the plan of care to evaluate effectiveness.
Measures the effectiveness of interventions as identified in the members care plan.
Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes.
Collects clinical path variance data that indicates potential areas for improvement of case and services provided.
Works with members and the interdisciplinary care plan team to adjust plan of care, when necessary.
Educates providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care.
Facilitates a team approach to the coordination and cost effective delivery to quality care and services.
Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum.
Collaborates with the interdisciplinary care plan team which may include member, caregivers, member`s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long term care services. Utilizes licensed care coordination staff as appropriate for complex cases.
Provides assistance to members with questions and concerns regarding care, providers or delivery system.
Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources.
Generates reports in accordance with care coordination goals.
Other Job Requirements
Responsibilities
Associate's Degree in Nursing required for RNs, or Master's Degree in Social Work or Healthcare-related field, with an independent license, for Social Workers.
Licensed in State that Services are performed and meets Magellan Credentialing criteria.
2+ years' post-licensure clinical experience.
Experience in utilization management, quality assurance, home or facility care, community health, long term care or occupational health required.
Experience in analyzing trends based on decision support systems.
Business management skills to include, but not limited to, cost/benefit analysis, negotiation, and cost containment.
Knowledge of referral coordination to community and private/public resources.
Requires detailed knowledge of cost-effective coordination of care in terms of what and how work is to be done as well as why it is done, this level include interpretation of data.
Ability to make decisions that require significant analysis and investigation with solutions requiring significant original thinking.
Ability to determine appropriate courses of action in more complex situations that may not be addressed by existing policies or protocols.
Decisions include such matters as changing in staffing levels, order in which work is done, and application of established procedures.
Ability to establish strong working relationships with clinicians, hospital officials and service agency contacts. Computer literacy desired.
Ability to maintain complete and accurate enrollee records. Effective verbal and written communication skills.
General Job Information
Title
CISC Care Coordinator, Licensed
Grade
24
Work Experience - Required
Clinical
Work Experience - Preferred
Education - Required
Associate - Nursing, Master's - Social Work
Education - Preferred
License and Certifications - Required
DL - Driver License, Valid In State - Other, LISW - Licensed Independent Social Worker - Care Mgmt, LMHC - Licensed Mental Health Counselor - Care Mgmt, LMSW - Licensed Master Social Worker - Care Mgmt, LPCC - Licensed Professional Clinical Counselor - Care Mgmt, LPN - Licensed Practical Nurse - Care Mgmt, PSY - Psychologist - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - Preferred
Salary Range
Salary Minimum:
$58,440
Salary Maximum:
$93,500
This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
$58.4k-93.5k yearly Auto-Apply 60d+ ago
Assignment Readiness Counselor - Short Term and On Demand
Magellan Health 4.8
Remote job
Must hold an independent license in any state, such as LCSW, LPC, LMFT
The Assignment Ready Counselor (ARC) will provide coverage in short-term, surge and on demand situations resulting from the Military needs such as a post-deployment event or to cover an existing assignment for counselors who are absent. The Summer ARC counselor position covers assignments during the May 15th through September 15th time period, coinciding with the school summer break. With minimal guidance and oversight, provides the full breadth of Adult or Child and Youth Behavioral (CYB) counseling services to military service members and their families at military installations. These services may include non- medical counseling, training/health and wellness presentations, consultation with parents, personnel at child daycare centers and schools, and consultation to installation command regarding behavioral health issues affecting military personnel and their family members. ARC CYB counselors may be assigned to DoDEA schools and community schools and will need to have experience working in a school setting to qualify for ARC role in backing up a school position. CYB counselors may also be assigned to youth programs, summer camps, and on demand assignments. ARC adult counselors may be assigned to support MFLC services in a variety of military community and readiness centers, as well as on-demand and surge assignments. The counselors work closely with the installation and military branch Points of Contact (POC) to assure that the program is provided within scope and meets the needs of the installation.
Provides non-medical, short term, solution focused, counseling directly to adults, children, and youth of service members. Services include assessment, brief counseling and consultation, action planning, referral to resources (assuring linkage as appropriate), and follow-up as indicated.
CYB counselors will also have a focus on supporting the staff and personnel of CDCs, DoDEA and community schools, youth programs and summer camps as well as providing parent training and guidance.
Provides training and health and wellness presentations, participate in health fairs and other base/installation activities.
Enters counselor activity data daily through smart phone or web application assure that reporting is accurate from assigned installation while maintaining confidentiality and anonymity of service / family member.
The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.
Other Job Requirements
Responsibilities
Master's Degree from an accredited graduate program in a mental health related field, or social work.
With short notice, willing to accept assignments of undefined periods to include weekends.
Can cover, on a full-time basis, assignments of varying length from a weekend to two weeks.
Quickly builds rapport with service personnel clients, family members, students, parents and co-workers.
Adaptable to new working conditions, varying location rules, etc.; adjusts working style to align with each work environment.
Able to work effectively with minimal instruction and guidance.
Listens carefully to instructions provided.
With minimal notice, participates in regular in-services/training, Quality Improvement committees or other contract activities as assigned.
Requires ability to quickly engage and communicate with military members, spouses or children as assigned, in order to accomplish job functions, and to respond quickly to emergent situations in any physical location on a military installation and/or within a school setting, which includes the need to traverse short and/or long distances within the base to both indoor and outdoor locations, to maneuver through rugged, outdoor or uneven locations (e.g., steep inclines, stairs, grass), and work in outdoor weather and other military base conditions. Due to the nature of working on military installations or related worksites, counselors may need to comply with various site-specific requirements to work at designated locations. For example, for some assignments, counselors will need to have certain current immunizations or vaccinations and provide record of receipt.
Ability to prove US Citizenship and must be fluent in English.
Advanced knowledge of brief therapy and solution-focused counseling methods.
Prior military service/military family member and/or strong familiarity with military culture desired.
For CYB positions must meet the Magellan MFLC CYB criteria for experience with children and youth and specialty in child and adolescent development/psychology.
Creates a presence on the installation in which the service and family members feel comfortable approaching the counselor and recognize the program to be confidential; for CYB counselors -- creates a presence in child and youth settings, is available to children, youth, and staff. When working with children, counselor must abide by line of site protocol.
Establishes and maintains working relationships with community resources and provides appropriate linkages.
Partners with POC to provide Adult and CYB services in a manner that addresses the needs of the installation/facility. Develops an excellent working relationship with the installation/facility POC.
Manages duty to warn and restricted reporting situations according to DoD protocol and staffs the cases with Regional Supervisor/Regional Director.
Communicates with Regional Supervisors and participate in regular individual and group supervision, sharing information regarding trends and issues on the installations and in facilities to which they are assigned for substitute or on call services.
Responds to critical incidents and special requests as directed by the POC and approved by the OSD program manager.
General Job Information
Title
Assignment Readiness Counselor - Short Term and On Demand
Grade
MFLC ARC
Work Experience - Required
Clinical
Work Experience - Preferred
Education - Required
Master's - Behavioral Health, Master's - Social Work
Education - Preferred
License and Certifications - Required
Current licensure required for this position that meets State, Commonwealth or customer-specific requirements - Care MgmtCare Mgmt, DL - Driver License, Valid In State - OtherOther, LPC - Licensed Professional Counselor - Care MgmtCare Mgmt, Must be an independently licensed behavioral health clinician - Care MgmtCare Mgmt
License and Certifications - Preferred
This is a Service Contract Act (SCA) covered position. The pay rate and health and welfare allowance are specified in the applicable wage determination agreement.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
$31k-58k yearly est. Auto-Apply 60d+ ago
Project Manager I
Caresource 4.9
Caresource job in Dayton, OH
The Project Manager I is responsible for managing small complexity projects within programs or small complexity standalone projects.
Essential Functions:
Responsible for successful delivery of project
Ensure project milestone deliverables are completed and approved at every stage of the project lifecycle
Assist with the continuous improvement of project management best practices, processes, and tools
Responsible for ensuring project closure activities are completed
Lead stakeholders in the refinement of the project charter if applicable
Work with manager and collaborate with business owners on the identification and assignment of business resources
Develop and maintain project schedule and WBS
Work with manager and collaborate with IT point of contact on the identification and assignment of IT resources
Work with manager to develop project resource plan including forecasting of EPMO FTEs and contractors
Schedule project audits and ensure compliance to EPMO Governance audit requirements
Develop and maintain project budget if applicable
Capture and consolidate EPMO, IT, and business estimates for the Project
Assess, manage, and control project scope, schedule, and budget change impacts
Escalate issues to Business Owner, Program Manager, and EPMO Leadership as applicable
Maintain project stakeholder matrix
Drive cross-functional communication between impacted business and IT areas
Work with Talent Development and Communications to develop project communication and training plans
Schedule and facilitate project meetings including weekly status meetings and stakeholder meetings
Work with Manager to represent project in program meetings or in Portfolio Governance meetings
Capture and report on meeting notes, decisions, and action items
Accurately track and report project status against plan to stakeholders at all levels
Track, compile and report project metrics and budget
Advocate for and adhere to EPMO standards, tools and processes
Work with manager to implement mitigation strategies, contingency plans, and communicate/escalate to stakeholders
Maintain RAID for project items
Identify, log, assign and manage risks and issues
Maintain project SharePoint site and project document repository
Produce detailed reports, business decision documents, meeting minutes, and notification on assigned projects
Work with Manager to develop project operations and support plan
Perform any other job duties as requested
Education and Experience:
Associate Degree in Project Management or related field or equivalent years of relevant work experience is required
Minimum of one (1) year of program coordination or project management experience is required
Competencies, Knowledge and Skills:
Experience with Microsoft Office tools, including Project, Word, PowerPoint, Excel, Visio, Teams, Outlook, etc.
Experience working in project management software is preferred
Demonstrates analysis and reporting skills
Ability to drive/make decisions and solve problems
Demonstrates interpersonal and relationship building skills
Demonstrates critical listening and thinking skills
Ability to effective interact with all levels within the organization
Demonstrates effective written and verbal communication skills
Customer service oriented
Ability to lead a project team of up to five core members
Experience managing a project of up to $1M in budget
Ability to prioritize work and team assignments to deliver projects on time, on budget, and meeting stakeholders expectations
Demonstrates a sense of urgency
Basic understanding of project management processes, techniques and tools, and development lifecycle
Licensure and Certification:
None
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$62,700.00 - $100,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business
This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#LI-GB1
Zippia gives an in-depth look into the details of CareSource, including salaries, political affiliations, employee data, and more, in order to inform job seekers about CareSource. The employee data is based on information from people who have self-reported their past or current employments at CareSource. The data on this page is also based on data sources collected from public and open data sources on the Internet and other locations, as well as proprietary data we licensed from other companies. Sources of data may include, but are not limited to, the BLS, company filings, estimates based on those filings, H1B filings, and other public and private datasets. While we have made attempts to ensure that the information displayed are correct, Zippia is not responsible for any errors or omissions or for the results obtained from the use of this information. None of the information on this page has been provided or approved by CareSource. The data presented on this page does not represent the view of CareSource and its employees or that of Zippia.
CareSource may also be known as or be related to CareSource, Caresource, Caresource Management Group Co., Caresource Management Group Company and Dayton Area Health Plan.