Job Overview
Location
Remote
Job Type
Full-time
Category
Data Science
Date Posted
June 25, 2026
Full Job Description
đź“‹ Description
- • Execute quality, engagement, and contracting strategies for assigned markets, developing provisions based on cost, quality analysis, and monitoring key performance metrics
- • Serve as the lead for strategic provider engagement and market performance initiatives under manager supervision
- • Drive network performance, new product launches, and product expansion through targeted market engagement activities
- • Recruit, contract, and initiate credentialing processes for providers, ensuring timely and accurate loading into systems
- • Coordinate account strategies to enhance provider satisfaction, retention, and overall network engagement
- • Negotiate and renegotiate contracts with hospitals, ancillary providers, physicians, and behavioral health entities in alignment with corporate policies
- • Analyze financial data to inform network strategy, partnership development, and reimbursement rate establishment in collaboration with leadership and Finance
- • Maintain comprehensive knowledge of federal and state regulations governing provider contracting
- • Drive quality outcomes through implementation and support of Value-Based Reimbursement agreements with providers
- • Lead Joint Operating Committees (JOCs) with key health partners, developing and presenting provider performance data
- • Enhance provider effectiveness in population health through member health outcome and quality improvement techniques
- • Collaborate with Population Health Analytics team to exchange clinical and population-level member data
- • Assist in developing and implementing strategic plans with leadership and analytics teams
- • Work directly with providers to develop and enhance individual member engagement strategies
- • Serve as a Subject Matter Expert on specific provider types as requested
- • Provide on-site practice transformation support and education to providers participating in the CareSource Patient-Centered Medical Home (PCMH) program, aligned with NCQA standards
- • Resolve complex or non-routine provider issues within 30 days and communicate proactively as needed
- • Evaluate policy and process changes for provider impact, monitor implementation of key initiatives, and provide leadership on provider-affecting changes
- • Ensure regulatory compliance, accreditation standards, and participation in market audits
- • Mentor and train new hires in provider engagement and contracting processes
- • Travel greater than 50% of the time to perform duties, including on-site visits to provider practices
- • Maintain residency in assigned territory; exceptions considered only due to business need
- • Work flexible hours, including evenings and weekends, as required to represent CareSource
- • Utilize standard office equipment including telephone, photocopier, fax machine, and personal computer
- • Adhere to annual influenza vaccination requirements during flu season (October 1 – March 31)
- • Maintain a valid driver’s license, personal vehicle, and insurance for work-related travel
- • Clear driver’s license record check is required for employment
🎯 Requirements
- • Bachelor’s degree in a healthcare-related field or equivalent years of relevant work experience
- • Minimum of five years of healthcare experience, including three years in provider relations and/or provider contracting
- • Managed care experience required
- • Master’s degree preferred
- • NCQA PCMH experience preferred
- • Six Sigma Certification or Project Management certification preferred
🏖️ Benefits
- • Salary range of $72,200.00 - $115,500.00
- • Bonus opportunity tied to company and individual performance
- • Comprehensive total rewards package including well-being investments
- • Annual influenza vaccination requirement during flu season (October 1 – March 31)
- • Mobile worker position with travel exceeding 50% of time
- • Flexible work hours including evenings and weekends as needed
Skills & Technologies
Remote
Degree Required
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About CareSource Management Group Company
CareSource is a nonprofit, multi-state managed care organization headquartered in Dayton, Ohio. Founded in 1989, it administers Medicaid, Medicare Advantage, and Marketplace health plans serving over two million members in Ohio, Kentucky, Indiana, West Virginia, and Georgia. The company focuses on improving health outcomes for low-income and vulnerable populations through integrated care management, behavioral health services, and social determinants programs.
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