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Operations Specialist II

CareSource Management Services LLC
Dayton, OH
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84685274 292502806 Job Summary: The Operations Specialist II provides ...
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analytical support and leadership for project impacting Claims and key internal Claims projects. Essential Functions: Represent claims on cross-functional project work teams Submit, monitor and prioritize IT tickets for the Claims department Review special projects and identify issue trends and potential resolutions Assist with Onbase reporting and processes Develop and draft P&P's and job aides for Claims Assist in training claims staff on claims processing policy and procedures Assist in educating/training Business...
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5
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5
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Scrum Master II

CareSource Management Services LLC
Dayton, OH
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84685299 292502830 Job Summary: The Scrum Master I is responsible for ...
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assisting in guiding the Agile Team and organization on how to use Agile/Scrum practices and values. Essential Functions: Provide support to the team using a servant leadership style and lead by example. Responsible to hold team accountable to the tenants of agile and working agreements including the use of appropriate tools, standards and best practices Promote and demonstrate core agile principles of collaboration, prioritization, team accountability and visibility Empower the team to self-organize around achievement of...
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4
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5
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Operations Specialist II (Facets Dual Processing)

CareSource Management Services LLC
Dayton, OH
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84685284 292502812 Job Summary: The Operations Specialist II provides ...
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Summary
About the job:
analytical support and leadership for project impacting Claims and key internal Claims projects. Essential Functions: Represent claims on cross-functional project work teams Submit, monitor and prioritize IT tickets for the Claims department Review special projects and identify issue trends and potential resolutions Assist with Onbase reporting and processes Develop and draft P&P's and job aides for Claims Assist in training claims staff on claims processing policy and procedures Assist in educating/training Business...
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From:
OhioMeansJobs.com
Certifications / Licenses:
Workkeys
Applied Math
4
Graphic Literacy
5
Workplace Documents
5
apply
Detailed Job Information

Clinical Appeals Nurse

CareSource Management Services LLC
Dayton, OH
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84685311 292502859 Job Summary: The Clinical Appeals Nurse is responsible ...
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for processing clinical appeals and attending state hearings within compliance and regulatory standards, clinical guidelines, and contractual obligations. Essential Functions: Responsible for the completion of clinical appeals and state hearings from all states Perform clinical reviews of member and provider appeals for medical, dental, behavioral health, pharmacy, and waiver services Analyze medical records, supporting documentation, and applicable guidelines to make informed decisions Document clinical rationale...
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Workkeys
Applied Math
4
Graphic Literacy
5
Workplace Documents
4
apply
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Actuarial Analyst II (Federal Programs)

CareSource Management Services LLC
Dayton, OH
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84685309 292502854 Job Summary: The Actuarial Analyst II is responsible for ...
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providing timely, accurate, and actionable data, analysis and recommendations supporting the department, area, and corporate key initiatives. Essential Functions: Develops actionable recommendations to management relative to all analysis Calculates profitability reports on appropriate business segments Leads regular and ad-hoc analysis identifying opportunities to improve efficiency and affordability Leads regular and ad-hoc analysis/studies to evaluate assumptions used in other processes Participates in cross...
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6
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6
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Team Lead, Case Management, Integrated Care - RN/SW - Ohio Mobile

CareSource Management Services LLC
Dayton, OH
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84685294 292502827 Job Summary: The role of the Team Lead, Case Management - ...
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Integrated Care is to provide support, direction and assistance to Case Management staff. Essential Functions: Give effective and timely feedback to staff in regard to performance outcomes and progress toward goals Monitor work allocation to maximize output and effectiveness of staff Provide daily oversight of scheduling and attendance of personnel Monitor performance of staff members through ongoing audit process Provide ongoing training, mentoring, coaching and disciplinary action as needed Conduct regularly...
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Applied Math
4
Graphic Literacy
5
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4
apply
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Community Health Worker - Ohio Mobile

CareSource Management Services LLC
Dayton, OH
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84685290 292502825 Job Summary: The Community Health Worker participates as ...
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a member of the inter-disciplinary care team (ICT) to coordinate care for members. Essential Functions: Engage with the member in a variety of settings to establish an effective, professional relationship. Settings for engagement include but are not limited to; hospital, provider office, community agency, member's home, telephonic or electronic communication Accompany members to appointments and other social service encounters when necessary Coordinate logistics to support members' care plan goals and interventions -...
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Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
4
apply
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Configuration Systems Analyst III - (Pricing/Networx/SQL)

CareSource Management Services LLC
Dayton, OH
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84685302 292502840 Job Summary: The Configuration Systems Analyst III is ...
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responsible for managing and defining system configuration requirements. Essential Functions: Manage and define system configuration requirements. Responsibility for requirements, definition, document, design, testing, training and implementation support using appropriate templates or analysis tool Develop and utilize reports to analyze and stratify data in order to address gaps and provide answers to issues identified within the department or by other departments Identify, manage and document the status of open issues,...
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Certifications / Licenses:
Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
5
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Team Lead, RX Solutions Center

CareSource Management Services LLC
Dayton, OH
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84685308 292502845 Job Summary: The Team Lead for the Rx Solutions Center ...
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plays a vital role in overseeing the daily operations of the team. This position involves supervising staff members, ensuring that they are well-supported and equipped to succeed in their roles. The Team Lead provides essential technical guidance, helping team members navigate complex issues and ensuring that they have the resources and knowledge needed to perform their tasks effectively. The Team Lead is responsible for reviewing work tasks to maintain high-quality standards across the team. This includes evaluating...
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From:
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Certifications / Licenses:
Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
5
apply
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Supervisor

CareSource Management Services LLC
Dayton, OH
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84685287 292502791 Job Summary: The Medical Director, Ohio Market is ...
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responsible for participating in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards. Essential Functions: Collaborate with market/product leaders to help define market strategy Represent CareSource at state and regulatory venues Provide prior authorization medical reviews, consultation and clinical review services Conduct clinical reviews for designated CareSource members Identify utilization management trends and...
Location:
Job Type:
Occupation:
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From:
OhioMeansJobs.com
Certifications / Licenses:
Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
5
apply
Detailed Job Information
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