CareSource

You would oversee grievance, appeal, and state hearing teams, ensure compliant and timely resolutions, analyze operational trends, develop staff, and implement process improvements. | You need a bachelor’s degree or equivalent, at least three years of management experience, and four years in grievance and appeals, preferably in healthcare. | Job Summary: The Manager, Grievance and Appeals is responsible for oversight of the Grievance, Appeal, IRE/IRO and State Hearing teams within CareSource. Essential Functions: Provide leadership and direction to staff to ensure the goals and standards of the department and CareSource are successfully achieved Manage staff to ensure timely and accurate completion of tasks and issues are accomplished Oversee and monitor processes to ensure department is meeting all regulatory requirements and accreditation standards Oversee and ensure grievances and appeals are resolved and reported appropriately Oversee, analyze and provide feedback to all areas that submit grievances and appeals Develop, implement and execute grievances and appeals training to business areas as needed Analyze and evaluate operations and identify process improvement Identify irregular trends with grievances and appeals; work with other areas as appropriate to identify root causes and appropriate steps for resolution Monitor trends and regulatory changes for impact to the department Report data to appropriate committees with CareSource Oversee, develop and execute the grievances and appeals process for new product lines Review and interpret regulatory requirements and ensure business policies and processes are in compliance Lead initiatives to track and trend grievances and appeals data in order to drive process improvements Develop a culture of accountability and flexibility within the team to support the organizational mission and vision Perform any other job duties as requested Education and Experience: Bachelor’s degree or equivalent years of relevant work experience is required Prior experience in the healthcare industry is preferred Minimum of three (3) years of management experience is preferred Minimum of four (4) years of grievance and appeals experience is preferred Competencies, Knowledge and Skills: Proficient in Microsoft Office Suite to include Word, Excel and PowerPoint Basic experience with ACD systems Basic experience with Call Management Systems Excellent written and verbal communication skills Strong interpersonal skills, high level of professionalism and a collaborative management style Effective problem solving skills with attention to detail Effective listening and critical thinking skills Ability to work independently and within a team environment Ability to develop, prioritize and accomplish goals Strategic management skills Familiarity of the healthcare field with knowledge of Medicaid and Medicare Ability to work in a fast-paced and constantly changing environment Licensure and Certification: None Working Conditions: General office environment; may be required to sit or stand for extended periods of time Compensation Range: $83,000.00 - $132,800.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (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 job description 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-KM1 Brand=CareSource

Provide technical leadership and governance for releases, deployments, and environment management while overseeing system architecture and driving the development lifecycle, including AI-enabled productivity improvements. | Requires a bachelor's degree, at least five years of systems management and analysis experience, and proficiency in Agile, DevOps, and technical leadership; cloud experience is preferred. | Job Summary: The Technical Delivery Lead, EES is responsible for owning technical delivery and technical management for Release & Environment Management (RM/EM), is responsible for providing technical leadership, governance, and continuous improvement for enterprise release management, deployment processes, and environment management services, ensuring reliable and compliant software delivery across the organization. Essential Functions: Prioritize team activities based upon IT leadership priorities and bandwidth Represent IT in project/business meetings and engagements Improve solution functionality and efficiency with added business value Collaborate closely with other business areas to optimize the use of systems and applications Collaborate with the department manager to systematically evaluate currently deployed services; develop and manage plans to optimize delivery and support mechanism Apply creative thinking in problem solving and identifying opportunities for improvement Provide subject matter expertise for technical guidance, training and direction Provide direction, lead and review of work products and daily tasks for quality Design, architect, and oversee the development of complex software systems, ensuring scalability, reliability, and maintainability Drive the full development lifecycle, from requirements gathering and design to implementation, testing, and deployment Establish and enforce coding standards, best practices, and development methodologies within the team Conduct regular code reviews to ensure code quality, performance, and adherence to architectural principles Identify technical risks and propose effective mitigation strategies to ensure project success Collaborate with product managers to prioritize and schedule project deliverables based on business objectives and resource availability Provide accurate and timely progress updates to project stakeholders, highlighting achievements, challenges, and proposed solutions Stay up to date with the latest industry trends, technologies, and frameworks, and evaluate their potential application in the organization Drive AI adoption and business outcomes by identifying, prioritizing, and delivering AI-enabled capabilities that improve productivity, quality, customer experience, speed to market, risk management, or cost efficiency within their area of responsibility. Build AI capability within their organization by ensuring their teams are equipped, trained, and expected to leverage AI tools and practices to improve effectiveness, accelerate delivery, and continuously evolve the way work is performed. Lead release governance, deployment readiness, and environment management practices to ensure reliable and compliant software delivery. Drive adoption of deployment automation, CI/CD standards, and engineering best practices to improve delivery efficiency and quality. Identify and mitigate release, deployment, and environment risks through proactive planning, governance, and cross-functional coordination. Define and monitor operational metrics, dashboards, and reporting to provide visibility into release performance, environment health, and service effectiveness. Establish and enforce release, environment, and deployment standards, ensuring adherence to organizational, security, and regulatory requirements. Perform any other job related duties as requested. Education and Experience: Bachelor's degree in Business, Computer Science or related field required Equivalent years of relevant work experience may be accepted in lieu of required education Five (5) years of systems management and analysis experience required Three (3) years of experience within Technology/Architecture leadership preferred Experience with Agile methodologies required Project planning and project management experience preferred Experience with Product Management environment and Cloud technologies preferred Competencies, Knowledge and Skills: Expert level skills in technical architecture, project management, and team collaboration Strong analytical, evaluative and problem solving abilities Knowledge of the healthcare and managed care philosophy is preferred Strong knowledge of Release Management, Environment Management, DevOps practices, deployment automation, operational governance, and continuous improvement methodologies Critical listening and thinking skills Strong learning competency and ability to teach others Solid project planning and management abilities Technical teaching, programming, analysis and specification skills Network protocols and security standards (may require) Application development tools methodologies (e.g. Agile) and Architecture skills Strong knowledge of best practices relative to application development or infrastructure standards Excellent written and oral communication skills Effective organization and prioritization skills Licensure and Certification: Cloud certification preferred Working Conditions: General office environment; may be required to sit or stand for extended periods of time Travel is not typically required Compensation Range: $94,100.00 - $164,800.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (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 job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-GM1 Brand=CareSource

Lead regulatory compliance and accuracy assurance, partnering across the enterprise to transform operations through automation, auditing, and control frameworks. | Requires a bachelor's degree, at least five years of healthcare operations experience including three years with Government Program products, and five years of leadership experience. | Job Summary: The Director, Operations Regulatory and Accuracy Assurance Oversight is responsible for representing and leading regulatory, compliance, and accuracy assurance activities on behalf of the Operations division. This senior-level leader serves as the Operations liaison to enterprise Regulatory, Compliance, Audit, and other assurance partners; leads independent evaluation of operational outcomes and processes for accuracy; and advances automation-enabled controls and operational efficiencies. Essential Functions: Serve as the Operations liaison and coordinate with enterprise Compliance, Regulatory, Legal, and Audit leaders on behalf of Claims, Configuration, Enrollment, Payment Integrity, Grievance & Appeals, Encounters, and Provider & Member Data. Represent Operations internally and externally with regulators and auditors, coordinating responses, requests, audits, investigations, and remediation with the appropriate enterprise partners. Partner with operational leaders and Regulatory and Legal teams to interpret and implement laws, regulations, guidance, contracts, and related requirements. Lead Operations accuracy assurance, including risk-based and independent auditing of operational outcomes and processes; identify root causes, report findings and trends, and oversee corrective actions through sustainable resolution. Establish and advance automated auditing capabilities, including agentic approaches, to expand testing coverage, improve timeliness, and strengthen ongoing monitoring while maintaining appropriate governance and human oversight. Lead transformation of Operations teams and workflows to increase automation, accuracy, efficiency, and control effectiveness; define measures of success and monitor realized outcomes. Monitor regulatory and legislative changes and coordinate timely communication and implementation across impacted Operations areas. Draft clear, timely operational responses for state agencies, departments of insurance, and other regulators in coordination with internal stakeholders. Maintain integrated tracking and reporting for regulatory, compliance, audit, and accuracy assurance matters, including risks, action plans, and remediation status. Keep direct-line leadership and the Corporate Compliance Officer informed of material regulatory initiatives, compliance concerns, accuracy risks, operational issues, and associated corrective actions; provide Operations status reporting to the Corporate Compliance Officer and applicable committees. Build strong relationships with key leaders and business partners to identify, prioritize, and mitigate operational and compliance risks. Perform any other job related duties as requested. Education and Experience: Bachelor's degree in business or related field required Master's degree preferred Equivalent years of relevant work experience may be accepted in lieu of required education Five (5) years of healthcare operations experience including three (3) years in Government Program products required Five (5) years of leadership experience required Experience leading operational accuracy assurance, quality auditing, control testing, or equivalent assurance activities is required Demonstrated experience transforming operational teams and processes through automation, workflow redesign, and measurable efficiency improvement is required Demonstrated experience applying automation and artificial intelligence to operational auditing or monitoring, including agentic use cases, governance, validation, human oversight, and sustained production performance is preferred Compliance oversight leadership experience within healthcare operations strongly preferred Competencies, Knowledge and Skills: Advanced proficiency in Microsoft Word, Excel, and PowerPoint Strong data analysis, trending, root-cause analysis, and performance measurement skills Deep knowledge of healthcare operations concepts, practices, procedures, and accuracy-control frameworks Demonstrated understanding of compliance and regulatory requirements for managed care and government programs, including CMS, HHS, departments of insurance, and Medicaid agencies Knowledge of automated auditing, continuous monitoring, artificial intelligence, and agentic solutions, including appropriate governance, testing, validation, and escalation controls Ability to translate assurance findings and operational data into prioritized actions, sustainable process improvements, and executive-level reporting Demonstrated transformation leadership, including operating-model design, workflow automation, change management, and benefits realization Strong strategic leadership, stakeholder management, negotiation, and decision-making skills Excellent written and verbal communication skills Ability to work independently and collaboratively, manage competing priorities and project timelines, and maintain strong attention to detail Customer-focused critical thinking, listening, and problem-solving skills Licensure and Certification: Certified in Healthcare Compliance (CHC) preferred Working Conditions: General office environment; may be required to sit or stand for extended periods of time Ability to travel as required by the needs of the business. Compensation Range: $113,000.00 - $197,700.00 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 job description 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 Brand=CareSource