CareSource jobs

The Managing Actuary provides leadership and direction to ensure team goals and strategies are successfully achieved. Essential Functions: Responsible for pricing, forecasting, reserving or other actuarial processes including development of key assumptions, as well as evaluation of financial experience and trend drivers Develop and communicate actionable and strategic recommendations to leadership in support of company goals Manage the development and maintenance of actuarial models to support key business goals and initiatives, such as actual to expected experience reporting, actuarial reserves and accruals, bid pricing/rate filings, forecasting, and contracting models Own the actuarial processes being managed (i.e., rate/bid filings, pricing, forecasting, reserving) within the company and with external vendors for assigned lines of business Specific function may require performing baseline analysis on expectations of rate changes for future years and work with federal and state agencies to support rate filings and other relevant activities Specific function may require overseeing development and review of Incurred But Not Reported (IBNR) reserve estimates for all CareSource lines of business on a monthly basis Perform any other job related instructions as requested Education and Experience: Bachelor's degree in actuarial science, mathematics, economics or a related field or equivalent years of relevant work experience is required Two to three (2 to 3) years or more of management experience is preferred Two to three (2 to 3) years or more of actuarial experience is preferred Strong database (SQL, SAS or Access) experience is preferred Managed care or healthcare experience is preferred Preferred: Experience leading Medicaid rate advocacy in at least one state Preferred: Understanding of accounting concepts such as accruals Competencies, Knowledge and Skills: Excellent written and verbal communication skills Excellent listening and critical thinking skills Strong interpersonal skills and high level of professionalism Ability to manage, develop, and motivate staff Ability to develop, prioritize and accomplish goals Ability to interact with all levels of management as well as external stakeholders Excellent problem-solving skills with attention to detail Excellent auditing and peer reviewing skills Ability to work independently and within a team Ability to effectively analyze data, develop/maintain appropriate models, draw and report findings and/or conclusions tailored for respective audiences Demonstrate sound business judgment when drawing conclusions and making recommendations Communicate status and results of processes, projects, goals and tasks with leader as needed or requested Expert proficiency level with Microsoft Excel Advanced proficiency with Microsoft Suite to include Word and Power Point Knowledge of SQL, SAS, R, Python or other data manipulation software Licensure and Certification: Associate of the Society of Actuaries (ASA) is required Fellow of the Society of Actuaries (FSA) is preferred Working Conditions: General office environment; may be required to sit or stand for extended periods of time May be required to travel less than 10% of the time Compensation Range: $92,300.00 - $161,600.00 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/salary): Salary Organization Level 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

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: $70,800.00 - $113,200.00 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/salary): Salary Organization Level 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

The selected candidate must live in Hawaii Customer advocate role supporting our members and providers, facilitating care and service. This is a service position providing assistance to Magellan's members, providers, and clients regarding various aspects of our programs, policies, and procedures. Responsibilities include handling incoming/outgoing calls related to healthcare related benefits. Responsibilities also include the administration of intake documentation into the appropriate systems. Overall expectations are to provide outstanding service to internal and external customers and strive to resolve callers' needs on the first call. Performance expectations are to meet and/or exceed customers' expectations and our quality standards. Researches, articulately communicates medical information regarding a variety of services including: educating providers on claims, member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality/Protected Health Information (PHI.). Meets key performance indicators and service standards while showing compassion to members and providers per Magellan's values and mission. Identifies and responds to crisis calls with appropriate resource. Facilitates routine referrals and triage decisions not requiring clinical judgment. Comprehensively assembles and enters patient information into the appropriate delivery system. Demonstrates flexibility in areas such as job duties and schedule to aid in better serving members and help Magellan achieve its business and operational goals. Supports team members and participate in activities to help build a high-performance team. Assumes full responsibility for self-development and career progression; proactively seek and participate in ongoing training sessions (formal and informal). Responsible for staying abreast of operational changes, updating self to ensure accuracy. Assists efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies. Leads or participates in activities as requested that help improve Care Center performance, quality, and culture. Navigate Magellan's systems, document customers' comments/information and forwards required information. Responsible for reading and retaining information disseminated through multiple resources, ensuring calls are addressed accurately and appropriately per account information. 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 1- 2 or more years of customer service experience. Must be able to talk and type simultaneously, with attention to detail. Must be flexible in scheduling and comfortable with change as customer service is an ever-changing environment. Responsible for meeting monthly individual call center metrics. Must agree to recording and evaluations for training and compliance. Must be proficient with keyboard functions and navigation between multiple computer applications General Job Information Title Customer Experience Associate- HMSA (Remote, must reside in Hawaii) Grade 17 Work Experience - Required Customer Service Work Experience - Preferred Call Center, Healthcare Education - Required GED, High School Education - Preferred Associate, Bachelor's License and Certifications - Required License and Certifications - Preferred Salary Range Salary Minimum: $31,175 Salary Maximum: $46,765 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.

Exemption Status:United States of America (Exempt)$130,148 - $182,208 - $234,267 “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 Description Essential Duties and Responsibilities include the following. Other duties may be assigned. Manages Account Executive development of client-specific business plans focused on the client's goals, performance expectations, growth in membership and profitability. Ensures that deliverables are on time, within budget, and meet the quality levels expected by MedImpact's internal and external customers. Provides direction and management over Key and LAMP Account Management teams to monitor the quality of products and services being offered to the client. Trains new staff members and provides on-going coaching to existing Account Management teams. Optimizes potential for sustainable growth and profitability. Identifies and aligns required resources to achieve business goals in book-of-business. Develop and maintain solid business relationships with region's clients at the executive and key decision-maker levels. Determines where to make “focused investments” for each account. Utilizes financial and pricing models to analyze and present business and clinical scenarios to client illustrating different benefit strategies and advantages of adoption. Researches and analyzes market trends and competitive practices to ensure client strategy is placed in context of client's industry and marketplace. Monitors client service continuum including proactive and reactive components. Resolves escalated issues, while ensuring ongoing issues are resolved expeditiously. Performs 360o review of performance on account, from operational service delivery to relationship management. Identifies gaps and sources of corrective action to ensure milestones are met. Collaborates with leaders in Operations, IT, Health Services and the other Directors. Supervisory Responsibilities Manages assigned staff in the segment area. Responsible for the overall direction, coordination, and evaluation of this unit. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. Supports and enforces all company policies and procedures in a fair and consistent manner, taking corrective action whenever necessary. Client Responsibilities This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written). One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients. Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below 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. Education and/or Experience Bachelor's degree (Master's degree preferred) and a minimum of ten (10) years related experience and eight (8) years of SME in respective area(s); (or equivalent combination of education and experience) with at least eight (8) years leading individual contributors, leaders, and leaders of leaders; which may be substituted with an appropriate mix of leadership experience and 10 years of MedImpact experience plus an appropriate external leadership training program and internal mentorship with a seasoned leader (VP+ level) that must completed within 12 months in new position Required experience depends on assigned book of business. Self-Insured - Experience in the Self-Insured benefits arena, experience with health plans/white label required. Location - Remote - Eastern or Central Region Computer Skills Intermediate to advanced computer skills; proficient with MS Office/Outlook and client databases Certificates, Licenses, Registrations None currently required. Other Skills and Abilities: Working knowledge of the health benefits arena, government prescription programs, preferably in pharmacy benefits management required; knowledge of healthcare products and contracts preferred; Consultative selling and negotiation skills; Demonstrated experience creating and delivering client presentations using; Strong verbal, written, interpersonal, presentation, persuasion and consulting skills required; Good interpersonal skills, excellent communication, writing and presentation skills essential; Other Qualifications Outstanding knowledge of the health benefits arena, preferably in pharmacy benefits management “PBM” or other managed healthcare services to national and regional managed care organizations, insurance companies, and other health related entities. Reasoning Ability Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Mathematical Skills Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry Language Skills Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Competencies To perform the job successfully, an individual should demonstrate the following competencies: Business Acumen Directing Others Organizational Agility Conflict Management Drive for Results Political Savvy Customer Focus Innovation Management Strategic Agility Decision Quality Managerial Courage 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 frequently required to use hands to finger, handle, or feel and reach with hands and arms. The employee is occasionally required to stand; walk and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. 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. While performing the duties of this Job, the employee is occasionally exposed to moving mechanical parts; fumes or airborne particles and risk of electrical shock. The noise level in the work environment is usually moderate. Work Location This position works on-site at the San Diego Headquarters or other company location (or from a remote location with management approval based on business requirements). Must provide adequate support to internal clients; be available for regular interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as be available to facilitate effective decisions through collaboration with stakeholders. Working Hours This is an exempt level position requiring one to work the hours needed to get the job done. Therefore one must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required. This 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, often supporting multiple time zones depending on assigned book of business. Travel This position requires domestic travel of up to 50% of the time with little or no advance notice. 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.

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: $61,500.00 - $98,400.00 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 (hourly/salary): Salary Organization Level 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

The Healthcare Analyst II is responsible for analyzing healthcare utilization and costs to identify patterns, variation, and outliers. Identify and quantify opportunities to reduce medical costs and understand their related financial outcomes. Essential Functions: Analyze healthcare utilization to identify patterns, variation, and outliers. Identify and quantify opportunities to reduce medical costs within the markets Evaluate the effectiveness of medical cost reduction initiatives. Support tracking and reporting of medical cost reduction initiatives. Work with Actuarial and Market Finance teams to accurately accrue and forecast the savings impacts of medical cost reduction initiatives. Understand the measurement of financial outcomes related to medical cost reduction initiatives. Develop tools to efficiently compare market performance across and within products. Support reporting on realized savings using sound analytical and financial techniques Work collaboratively with cross functional teams, including department leaders and operators, to understand/track operational details of medical cost reduction initiatives. Support the intake, prioritization and coordinated execution of ad-hoc analytics requests from departments across the organization Perform any other job duties as requested Education and Experience: Bachelor's Degree or equivalent years of relevant work experience is required Minimum of two (2) years of experience in healthcare analytics is required Managed care experience is strongly preferred. Experience with financial analysis is required, health plan preferred. Competencies, Knowledge and Skills: Knowledge of healthcare data, including medical and pharmacy claims, EMR data, HIE data, UM data and demographic data Knowledge of Medicaid, Medicare and other government sponsored healthcare programs is preferred Proficient in with Excel, Word and PowerPoint Proficient with Transact-SQL or SAS or Microsoft Power BI or Tableau Proficient in Financial reporting concepts Ability to organize data in a way that facilitates inferences, conclusions and decisions Compensation Range: $70,800.00 - $113,200.00 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/salary): Salary Organization Level 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

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.

Social Worker - Masters Degree (required) Health Systems Management, Inc. (HSM) is a full-service healthcare management organization providing a full range of development, management, and administrative services for dialysis facilities over the past 35 years in Georgia, South Carolina, and North Carolina. HSM has an outstanding reputation in the renal community for providing high quality patient care and encouraging physician input while maintaining efficient business operations. We are currently seeking compassionate, dedicated, and highly motivated Social Workers to join our dialysis team. Social Worker Responsibilities and Physical Demands: Provides direct and indirect interventions to pre-dialysis and chronic dialysis patients. Provides clinical services in collaboration with the multidisciplinary health care team in order to assist patients in reaching their fullest rehabilitative potential. Communicates with patients and their support system to establish plan of care. Completes comprehensive psychosocial assessment. Assesses family dynamics and need for further interventions. Utilizes appropriate community resources in order to meet patient/family concrete needs. Social Worker Education Requirements and Position Qualifications: Master's degree in Social Work required. Ability to solve practical problems and deal with a number of concrete variables in situations. Must be able to work independently and plan/organize priorities autonomously. Willingness to work a flexible schedule and to fill in when needed. Excellent bedside manner and communication skills. Social Worker Benefits: Extensive Benefits Package to Include: Medical and Prescription Coverage Options Dental Vision Flexible Spending Account Short and Long-Term Disability 401K with Company Match Paid Time Off - start accruing time on your first day with the company Sign on and referral bonuses for qualified positions Employee Assistance Program for: Family Resources, Counseling, Financial, and Legal Guidance Paid on the job training. The training is a combination of classroom setting and direct patient care. Option to work remotely 1 day per week once training is completed. And more... HSM, INC maintains a drug-free workplace in accordance with state and federal laws. Health Systems Management, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, age, marital status, pregnancy, genetic information, or other legally protected status.

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.

The Care Guide Plus - Community Based role is responsible for participating as a member of the inter-disciplinary Care Coordination Team to coordinate care for members, meeting their individual needs and the needs of the population. The Care Guide serves as a single point of contact for care coordination when there is no CCE or OhioRISE Plan and/or CME involvement and short-term care coordination needs are identified. The Care Guide Plus serves as a single point of contact for care coordination when there is a CCE, OhioRISE Plan, and/or CME involvement and short-term care coordination needs are identified. Members needing Care Guide or Care Guide Plus assistance for longer than 60 calendar days should be considered for referral to a Care Manager. 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 Participate in the identification of the individual's needs and prioritizes efforts in collaboration with the member and caregivers. Gather information to identify and manage barriers to care Take appropriate steps to close gaps in care where appropriate Under the supervision of the Care Manager, implement effective interventions based on clinical standards and best practices Maximize the client's health, wellness, safety, adaptation, and self-care through effective care coordination Educate the member and other stakeholders about treatment options, community resources, insurance benefits, etc. so that timely and informed decisions can be made Gather information to assist the Care Manager to evaluate the member's response to the plan of care as requested Evaluate client satisfaction through open communication and monitoring of concerns or issues; assist members in filing of Grievances & Appeals as appropriate Collaborate with Care Managers and providers to plan for post-discharge care needs or facilitate transition to an appropriate level of care in a timely and cost-effective manner Document care coordination activities and member response in a timely manner according to standards of practice and CareSource policies regarding professional documentation Starts each interaction with members wondering, “What does the world look like for this person, and how can I meet him or her where they are? What are his or her unique needs, and how can CareSource help?” In each interaction, the employee will aspire to help the member to feel informed, empowered, and supported by CareSource 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 Document all transitions of care, including sentinel events, in the MCO and OhioRISE Care Coordination Portals (CCP) Once documented, will send electronic notifications of sentinel events to the member's authorized users in the MCO or OhioRISE Care Coordination portals Serve as Central Point of Contact for OhioRISE, CCE, and CME entities The Care Guide Plus will collaborate with OhioRISE, CCE, and CME entities to obtain and share any Release of Information (ROI) information and documentation in order to maintain HIPPA and other privacy requirements Trained to administer the CANS assessment Regular travel to conduct member visits, provider visits and community based visits as needed to ensure effective administration of the program Perform any other job duties as requested Education and Experience: Associate's Degree or equivalent years of relevant work experience is required Minimum of one (1) year of clinical experience in nursing, social services, or healthcare field (discharge planning, case management, care coordination, and/or home/community health experience) is required Medicaid and/or Medicare managed care experience 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 and 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 and 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: Clinical or Care Management Certification 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. If the driver's license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated Employment in this position is conditional pending successful clearance of a criminal background check. If the criminal background results are unacceptable, the offer will be withdrawn or, employee has started in position, employment in this 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: Mobile Worker: This is a mobile position, meaning that regular travel to different work locations 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. 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. A valid driver's license, car, and insurance are necessary for work related travel 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 Compensation Range: $46,500.00 - $74,500.00 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 (hourly/salary): Hourly Organization Level 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

Dayton, OH/Hybrid Outside of Dayton area may be considered for remote The Pharmacy Technician II - Rx Solutions Center (RSC) is responsible for handling member, pharmacy, and provider calls related to pharmacy clinical campaigns. This role will require collaboration across different areas within CareSource to ensure best in class service is delivered to our members. Essential Functions: * Performs technical and clerical duties that do not require the professional clinical judgement of a pharmacist (i.e., confirms member identity, updates demographic information, updates provider information, faxes providers, etc.) * Receive and respond to incoming calls. Take appropriate action based off protocols & use critical thinking skills to escalate issues to appropriate parties, when needed * Ensure each member has a positive experience by providing accurate information and a high level of customer service * Accurately enter information into appropriate systems in a timely manner allowing for data collection to measure outcomes * Collaborate with other departments in the provisions of member care * Meets or exceeds productivity and performance expectations * Establish & maintain professional working relationships with all stakeholders * Perform any other job duties as requested Education and Experience: * High School Diploma or equivalent years relevant work experience is required * Three (3) years retail pharmacy or hospital pharmacy experience is preferred * Minimum of One (1) year clinical call center experience is required Competencies, Knowledge, and Skills: * Computer proficient with basic knowledge in Microsoft Office Suite to include Outlook, Word, Excel, and PowerPoint * Highly customer service oriented * Knowledge of the healthcare field * Understands the pharmacist's clinical role in the care of members * Familiarity with medical terminology and medication names * Organized and learns quickly * Uses proper grammar in print and e-mail communications * Excellent attendance and punctuality * Ability to work independently and within a team environment * Attention to detail * Critical listening and thinking skills * Time management skills * Decision making/problem solving * Comfortable working in a fast-paced environment Licensure and Certification: * Ohio Technician Registration required * Pharmacy Technician Certification (CPhT) is preferred * Ability to acquire state registration in multiple states, as required Working Conditions: * General office environment; may be required to sit or stand for extended periods of time * Position requires the ability to work 9 am to 5:30 pm and the flexibility to work weekends and overtime, as needed Compensation Range: $35,200.00 - $56,200.00 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/salary): Hourly Organization Level 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

Configuration Architect is responsible for the definition, oversight, coordination and development of designs and processes along with related road maps and lifecycle management to provide custom configuration solutions. This position Needs experience with Networx. This position will drive solutions for implementation. Essential Functions: Work independently and closely with department team members, business, software vendors and IT teams on medium to large complex projects to understand the business requirements that drive the analysis and design of technical and process solutions Develop project plans incorporating project variables, prepare status reports on project activities, conduct status checks to assess progress against plan and communicate progress Act as liaison between corporate business areas and collaborate with appropriate business areas to implement proposed solutions and manage programs to evaluate effectiveness and results Troubleshoot existing solutions to identify errors or deficiencies and develop solutions Research, review, recommend, communicate, and implement solutions which identify problems/root cause of issues Evaluate existing solutions and applications and provide recommendations for improving the application by performing gap analysis and identifying feasible alternative solutions Provide technical support in analyzing content of patches, upgrades, and fixes to the production applications Develop prototypes and options for new system capabilities and work with leadership and business to identify value and opportunities to improve business capabilities Lead teams in obtaining and analyzing functional and system requirements for complex corporate initiatives and provide expert system consultation, analysis and recommendations to ensure the development solutions support the business needs Oversee configuration activities performed by other team members, ensuring alignment to the project's goals, budget and delivery schedule Work under limited supervision with considerable latitude for initiative and independent judgment Perform any other job duties as requested Education and Experience: Bachelor of Science degree in information technology, business intelligence or related field, or equivalent years of relevant work experience is required Minimum of seven (7) years of experience in advanced systems configuration, system/business solution analysis and business solutions development is required Minimum of five (5) years of health plan experience is required Minimum of two (2) years of experience in project management/leadership role is preferred Competencies, Knowledge and Skills: Advanced computer skills with Microsoft Word, Excel, Access, Visio, and abilities in Facets Proven understanding of database relationships required Expert knowledge of Facets data model Ability to facilitate and lead solution design activities Knowledge in creating and maintaining platform technology road maps Solid understanding of Managed Care Organization business workflow Excellent communication, presentation, and written skills Knowledge of Business Intelligence tools and methodologies Excellent understanding of industry standards and technology trends Critical listening and thinking skills Strong analytical, decision making, and problem-solving skills Attention to detail Ability to develop, prioritize and accomplish goals Ability to work independently and within a team environment Licensure and Certification: None Working Conditions: General office environment; may be required to sit or stand for extended periods of time Compensation Range: $92,300.00 - $161,600.00 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/salary): Salary Organization Level 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

The Director, Enterprise Value Based Reimbursement (VBR) Strategy serves as the enterprise-wide VBR strategy lead to all markets and lines of business. The Director will lead ongoing engagements with market leadership to build VBR strategy plans, collaborate with state partners around VBR strategy, and coordinate VBR program solutions for markets. Essential Functions: Support the development and execution of both enterprise-level and market-specific value-based reimbursement (VBR) strategies to enhance organizational alignment and effectiveness across various markets and lines of business. Collaborative with market leadership on VBR strategies that address specific requirements for Request for Proposals (RFPs), and continue collaboration post-RFP to build and implement effective VBR program plans. Partner closely with market leadership to ensure compliance with state-level VBR requirements and commitments by leveraging appropriate strategies and programs to meet regulatory expectations. Build strong, influential, and collaborative relationships with key internal stakeholders and external partners to shape and drive VBR program strategy. Lead discussions with healthcare providers and organizations that are instrumental in fostering enterprise-wide VBR partnerships. Continuously evaluate and adjust VBR programs to ensure they remain in alignment with enterprise objectives, enhancing their impact and relevance. Oversee the development and operationalization of policies, standards, benchmarks, performance metrics, and quality control mechanisms to ensure high standards in VBR strategy execution. Maintain up-to-date knowledge of regulatory changes and market-specific performance standards to guarantee compliance and ensure timely execution. Lead negotiations and contract discussions with healthcare providers identified as providing innovative care solutions that support a comprehensive national VBR approach. Provide leadership, mentorship, and professional development opportunities to staff, fostering a supportive environment that encourages growth and excellence in performance. Perform any other job related duties as requested. Education and Experience: Bachelor's degree in management, healthcare management or related field is required Master's degree is preferred Equivalent years of relevant work experience may be accepted in lieu of required education Five (5) years of experience in value-based reimbursement design, methodologies and/or VBR contracting, data analysis, reporting, or data support is required Three (3) years of Provider contracting or Provider relations is required Five (5) years of leadership/management experience is required Competencies, Knowledge and Skills: Proficient in Microsoft Office to include Word, PowerPoint, Access - advanced proficiency in Excel Excellent team facilitation skills High level of analytic skills for solving problems Excellent oral, written, and interpersonal communication skills Strong knowledge of Value Based Contracting methodologies and operations and/or experience in health care quality Knowledge of provider contracting and familiarity with provider network operations Critical listening and thinking skills Problem solving skills Attention to detail and work plan creation, implementation, and evaluation Business acumen and strategic thinking skills, yet able to execute tactically Strong relationship management skills and ability to maintain and build strong working relationships in a matrix 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: $110,800.00 - $193,800.00 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 (hourly/salary): Salary Organization Level 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-SW2

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.

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 Military and Family Life Counselor - Short Term Assignments or On Demand for On Site 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 Salary Range Salary Minimum: $59,922 Salary Maximum: $100,280 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.

The Medicare Sales Representative II is responsible for supporting the sales strategy and enrollment goals in collaboration with management to ensure goals are successfully achieved for the Medicare Advantage product line within an assigned territory and consistent with state and federal regulations. Essential Functions: Contribute and support the development of educational and enrollment opportunities with area agencies on aging, senior resources and associations, faith-based organizations, and other senior advocates in the community Conduct presentations, marketing activities and other educational events in accordance with current approved communication and marketing programs and state/federal regulations Assist in community outreach strategies and programs with guidance from internal departments and staff while adhering to all applicable state and federal regulatory requirements Serve as a subject matter expert on CareSource's Medicare Advantage product line, Medicare, and industry insights Serve as a liaison between the CareSource Health Plan and the community Communicate to Medicare beneficiaries accurately to ensure understanding of the product choices available to them during the enrollment process Meet and exceed monthly sales goals Build, foster and maintain strategic relationships to ensure sales success Execute assigned administrative duties as defined by management, including updates to and maintenance of appropriate reporting and database systems Meet customer expectations and requirements while maintaining balance with business requirements Regular travel to attend community events, conduct presentations and participate in sales meetings as needed to ensure success of the program Perform any other job duties as requested Education and Experience: High School diploma or GED is required; Associate's Degree in business, healthcare or related field, or equivalent years of relevant work experience is preferred Medicare or Medicaid sales experience, or other commercial sales insurance experience is required A minimum of one (1) year of experience in a sales or account management role in the insurance industry is required Competencies, Knowledge and Skills: Advanced in the use of Relationship Management tool (“CRM”) system; Sales Activity Reporting Highly proficient in Microsoft Suite, to include Word, PowerPoint and Excel Excellent computer, tablet, and cell phone skills Strong understanding of Federal and State regulatory requirement and Marketing Guidelines Models & supports CareSource Brand: Be empathetic, Be the answer, Be engaged Demonstrates clear understanding of and speaks with conviction about the populations we serve Acts in a way consistent with Consumer Experience ideals - models empathy, engagement and urgency to meet needs Practices excellent service Execute effective use of Sales Force Automation system Excellent computer skills Maintain regulatory knowledge for compliance to state regulatory insurance, CMS, and CareSource requirements Excellent written and verbal communication skills Able to work independently and within a team environment Capable of selling new products to existing customers Deep and broad understanding of products, services and solutions Bilingual is preferred Ability to interface with and influence external business partners through the use of excellent interpersonal skills Ability to demonstrate superior presentation and negotiation skills in both small and large group settings Advanced analytical and problem solving skills Effective listening and critical thinking skills Ability to develop, prioritize and accomplish goals Time and territory management Ability to lift up to 50lbs on occasion Licensure and Certification: Current, unrestricted Insurance License in Accident and Health within state(s) of assigned territory is/are required, or ability to achieve license within 30 days of hire Current Medicare Fraud, Waste, and Abuse (MFWA) certification required within 30 days of hire 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 the 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: Mobile Worker: This is a mobile position, meaning that regular travel to different work locations 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. 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. A valid driver's license, car, and insurance are necessary for work related travel 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 member and may refer members to other CareSource resources Compensation Range: $46,500.00 - $74,500.00 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 (hourly/salary): Salary Organization Level 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-AH1

The Women & Children's Health Specialist II leads regional partnerships with OB providers to ensure at-risk pregnant mothers receive enhanced medical care to drive improved birth outcomes. Essential Functions: Engage community of maternity care providers (Obstetricians, family medicine physicians, certified nurse midwives, nurse practitioners, FQHCs) through education and outreach to participate in the development of a maternal child home that mirrors the medical home model with regards to adoption of evidence-based practices, use of risk screening, coordination of care, and integration of case management for members at risk for poor outcomes Facilitate execution of agreements with practices interested in becoming maternal child medical homes (MCMH) Assure that local case management/care coordination entities develop and implement processes to achieve program goals Ensure the new MCMHs are connected to CareSource maternal child case management program and that maternal child case manager is assigned Monitor performance and processes of MCMHs, community partnerships within the CareSource network using reports generated from administrative, case management and chart audit data to identify and disseminate best practices and to identify and address outlier practices whose performance does not meet program standards. Develop and implement quality improvement activities, using data from the MCMH and Maternal Child Case Management programs Identify populations within CareSource membership that would benefit from focused maternal child case management and associated high risk and medical management programs Identify barriers to care completion and opportunities to improve quality of care and communicate barriers with CareSource business units to facilitate ongoing collaboration efforts Identify and partner with local community agencies, advocacy groups, etc. to develop relationships, enhance care coordination and improve health outcomes of pregnant members and infants and drive improved birth outcomes Collaborate with Center for Analytics to use data to facilitate identification of gaps in clinical care, screenings, to implement best practices to optimize HEDIS rates, increase provider satisfaction and drive HEDIS rate improvements Partner with providers to identify, prioritize and implement initiatives to engage members in completion of needed health care services and screenings Monitor and demonstrate impact of initiatives on HEDIS rate attainment by evaluating pre- and post-intervention data with providers; collaborate with providers to identify and prioritize subsequent targeted initiatives Utilize and expand Peer-to-Peer relationships between CareSource Medical Directors and providers to improve compliance with current evidence-based clinical practice guidelines Ensure alignment of all interventions with current evidence-based Clinical Practice Guidelines and the HEDIS Strategic Plan Identify provider coding opportunities to optimize both traditional and value-based reimbursement, reduce claims denials and integrate CareSource business partners in outreach efforts to increase provider satisfaction and drive improvement in HEDIS administration rates Regular travel to conduct member visits, provider visits and community based visits as needed to ensure effective administration of the program Perform any other job related instructions, as requested Education and Experience: RN Associate degree required; Bachelor of Science in Nursing (BSN) or related field or equivalent work experience required Minimum of five (5) years of experience in nursing, social management, case management, discharge planning, care coordination and or community/home health environment required Minimum of five (5) years of clinical experience is required; 3 or more years of clinical experience in pediatrics/maternity care preferred Minimum of three (3) years of Medicaid/Medicare preferred Minimum of two (2) years of supervisory/preceptor experience preferred Competencies, Knowledge and Skills: Data analysis and trending 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 pregnant members 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 Licensure and Certification: Current unrestricted license as a Registered Nurse (RN) in state of practice is required 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 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: Mobile Worker: This is a mobile position, meaning that regular travel to different work locations 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. 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. A valid driver's license, car, and insurance are necessary for work related travel 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 Perform regular travel to CareSource Headquarters for team meetings and other events as determined by Health Outcomes Management Team Compensation Range: $70,800.00 - $113,200.00 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/salary): Salary Organization Level 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

The Internal Auditor II works in a self-directed team environment to execute internal audits as defined by management and the Audit Committee with progressive latitude for team goal setting, initiative and independent judgement on collective work products. The auditor works to identify and evaluate organizational risk, recommends and monitors mitigation action and supports the development of the annual audit plan. Essential Functions: Conduct operational, performance, financial and/or compliance audit project work including, business process survey, project planning, risk determination, test work, recommendation development and monitoring and validation of remediation Work within a self-directed team environment with limited direct supervision, employing significant creativity in determining efficient and effective ways to achieve audit objectives Actively participate in the development and implementation of a flexible risk-based, flexible annual audit plan considering control concerns identified by senior management Coordinate and collaborate on internal audit projects including assessing the adequacy of the control environment to achieve defined objectives in accordance with the approved audit program and professional standards Facilitate communication of organizational risks and audit results to business owners through written reports and oral presentations and provide support and guidance to organizational leadership on effective internal control design and risk mitigation Coordinate, monitor, and complete team tasks within agreed upon timeframes and meet individual and team project timelines, which may be aggressive at times. Influences team prioritization and scheduling of work, problem solving, assignment of tasks, and takes initiative when problems arise. Provides cross-training of team members Support management in onboarding new team members through mentorship, shadowing, and training of all required functions and processes and influence standards for expected team behaviors Assist in the coordination of external audits of CareSource by government agencies, accounting firms, etc. Develop and maintain productive professional relationships with CareSource staff and management by developing trust and credibility Significant interaction with others in the Department of differing skillsets (clinical, IT, etc.), organizational management and staff throughout CareSource, including interaction with the senior most levels Coordinate audit projects as necessary with other CareSource functions, including CareSource Assurance teams Generally conform to IIA standards and maintain all organizational and professional ethical standards, even in difficult or challenging situations Willing to accept feedback, coaching and criticism from others, including peers and management both in Internal Audit or outside of Internal Audit, reflect on the information, and adapt when appropriate Perform any other job duties as requested Education and Experience: Bachelor's degree in finance, business management, healthcare administration, accounting or related field or equivalent years of relevant work experience is required Master of Business Administration (MBA), or other graduate degree is preferred A minimum of three (3) years of finance, business management, healthcare administration, accounting or related field is required; experience in internal auditing or public accounting is preferred Knowledge of audit principles and IIA Standards and Code of Ethics required Experience in risk and control assessments is preferred Experience in thoroughly documenting process flows and controls in financial, and/or business operations cycles preferred Experience with Sarbanes Oxley 404 or Model Audit Rule preferred Experience in health care or insurance fields is preferred Competencies, Knowledge and Skills: Strong communication skills, including proper writing skills adaptable for the audience and purpose, presentation skills for internal or external audiences and senior management, and interpersonal skills sufficient to develop strong professional relationships with CareSource management and staff Solid critical thinking skills including professional skepticism and problem resolution Data analysis and trending skills and ability to compose and present reports using audit data Ability to work in a matrix environment with responsibility for multiple deliverables for multiple functional areas within CareSource Team and customer service oriented Collaborative mindset and ability to operate in a self-directed team environment with collective accountability Strong ability to adapt to changing environment Strong self-leadership, organizational and time management skills Driven to proactively seek relevant development, education and training opportunities Strong sense of integrity and ethics in performance of all duties Takes initiative to identify and influence innovative process improvement Self-driven to work independently within a team environment Success in working in a self-directed matrixed environment Advanced level experience in Microsoft products Licensure and Certification: CIA, CISA, CPA, CMA, CRMA or other appropriate finance, IT or internal audit licensure or certification is preferred Working Conditions: Most work will be performed in an office or virtual setting; however, performing onsite audits may also be necessary depending on assignments May be required to sit or stand for extended periods Compensation Range: $61,500.00 - $98,400.00 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 (hourly/salary): Salary Organization Level 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

The Network Contract Specialist will be responsible for creating and maintaining behavioral health provider contracts across the New Mexico territory for Presbyterian Health Plan with Medicaid, Medicare, and Commercial lines of business. This role includes managing provider contracting activities in coordination with the Network team and processing all necessary contract-related updates. Key responsibilities include handling contract changes, Statements of Work, amendments, rate updates, Letters of Direction, and other required modifications. The specialist will also ensure all contract updates are compliant with internal policies and New Mexico-specific regulatory requirements. Strong collaboration with internal departments is essential to maintain network accuracy, provider data integrity, and overall operational efficiency. Detailed tracking and documentation of all contract activities and provider communications are critical components of this role. Support and maintain behavioral health provider contracts for Medicaid, Medicare, and Commercial lines of business across the New Mexico territory Perform provider contracting functions in collaboration with the Network team Process contract-related updates including: Exhibits Contract changes SOS Amendments Rate updates Letters of Direction (LODs) NCQA/CAQH Ensure compliance with internal standards and state-specific requirements Collaborate with internal departments to support network accuracy, provider data integrity, and operational efficiency Maintain thorough documentation and tracking of all contract activity and communications This position is responsible for the support of all activities related to developing and maintaining the physician, practitioner, group, and/or facility, MPPS and organization services delivery system in small to mid-size market defined by membership, number of providers in delivery system, number of business operating units and lines of business. Interacts with all areas of organization to coordinate network management and network administration responsibilities. Assesses network needs, analyzes network composition, and using organization databases, application of regulatory requirements, accreditation entities and other resources, recruits individual, group and/or organizational providers to meet network adequacy standards and assure quality network. Conducts and coordinates contracting and amendment initiatives. Provides issue resolution and complex trouble shooting for providers. Conducts provider education and provider relation activities, providing necessary written materials. Conducts administrative provider site visits and coordinates report development and completion according to contractual requirements or ad hoc requests. Coordinates Public Policy Research Center (PPRC) activities to assure maintenance of current credentialing status, and evaluation and appropriate actions of quality of care issues and complaints against providers. Conducts and manages ongoing audits of provider compliance with Magellan policies and procedures as well as contractual obligations for multiple customers. Develops work plans to address audit requirements. Works with management to draft, clarify and recommend changes to policies which impact network management. 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 Knowledge of National Committee for Quality Assurance (NCQA) requirements. Ability to work independently and prioritize activities. Intermediate knowledge of Microsoft Office Suite, specifically Excel. Strong presentations skills using PowerPoint. Minimum of 1 year experience in related position/field. General Job Information Title Network Management Specialist (Contract Specialist) Grade 21 Work Experience - Required Network Work Experience - Preferred Education - Required Education - Preferred Bachelor's 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.