Qureos Mentor

CareSource

CareSource is a health care organization that provides a variety of health insurance plans, including Medicaid, Medicare, and Marketplace options. They focus on offering affordable health coverage and support services tailored to the needs of individuals and families, including those with low income, disabilities, and special health care needs. CareSource emphasizes a member-centric approach, providing resources and tools to help members manage their health effectively.

<div>Job Summary:
The AVP, Actuarial Science, is responsible for driving and supporting company strategy and managing actuarial expertise in coordination with others to ensure actuarial soundness, and to use actuarial knowledge and tools to help improve profitability of CareSource&rsquo;s lines of business.
Essential Functions:<ul><li>
Drive company strategy and manage actuarial expertise in coordination with other leaders on all aspects of CareSource&rsquo;s actuarial functions. This includes pricing, forecasting, month-end close activities, and performance monitoring and explanations. Uses actuarial knowledge and tools to help improve profitability of the business area(s) they oversee.</li><li>
Oversee actuarial functions and assure the coordination, relevance, and performance in support of CareSource business needs</li><li>
Hold responsibility for necessary improvements and changes to models, reports, and processes to keep pace with evolving business needs</li><li>
Manage continual improvement of actuarial processes and make changes as needed to support the business</li><li>
Represent Actuarial Services and CareSource in written and verbal communications, presentations and meetings with regulators, owners and other outside parties regarding matters requiring actuarial expertise</li><li>
Support the alignment of Actuarial Services with Finance Department to assure the best possible business intelligence and understanding of company financials in communications to CareSource executive leadership</li><li>
Support decision making and strategy regarding actuarial inputs to the monthly financial reporting process and reports, such as claim reserves/accruals, variance analysis, and actuarial contributions to executive leadership reports</li><li>
Implement and maintain actuarial processes and controls consistent with best practices to assure accurate and timely reporting and handoff of actuarial components and inputs to financial reporting</li><li>
Perform any other job duties as requested</li></ul>
Education and Experience:<ul><li>
Bachelor&rsquo;s degree in actuarial science, mathematics, economics or a related field is required</li><li>
A minimum of ten (10) years of experience in the Actuarial Industry with a minimum of five (5) years of management experience is preferred</li><li>
A minimum of five (5) years of experience for the actuarial function in Healthcare, including Medicaid, Commercial and/or Medicare Advantage business; rate negotiations, process/model/report design, state and federal reporting requirements, as well as other traditional actuarial functions</li><li>
Managed care and state/federal government program experience preferred</li><li>
Experience interacting with state or federal regulators, CMS or other external regulatory or auditing entities preferred</li><li>
Experience communicating/presenting to internal senior leaders</li></ul>
Competencies, Knowledge and Skills:<ul><li>
Excellent strategic planning and process design skills</li><li>
Excellent PC skills, including advanced Excel, Word and PowerPoint</li><li>
Strong analytical skills</li><li>
Strong problem solving and critical thinking skills</li><li>
Ability to articulate and defend complex ideas and strategies to non-technical audiences</li><li>
Collaborative, with the ability to effectively influence others</li><li>
Fact-based decision maker</li><li>
Excellent oral, written and interpersonal communication skills</li><li>
Strong managerial and team-building skills, with proven track record of hiring and developing high performers</li><li>
A proven track record of achievement and integrity</li><li>
Strong grasp of business processes, operations, and other business partner competencies</li></ul>
Licensure and Certification:<ul><li>
Member of the American Academy of Actuaries (MAAA) and Associate or Fellow of the Society of Actuaries (ASA or FSA) is required</li><li>
Must maintain memberships in the Society of Actuaries and the American Academy of Actuaries</li></ul>
Working Conditions:<ul><li>
General office environment; may be required to sit or stand for extended periods of time</li><li>
May be required to travel less than 20% of the time</li></ul>
Compensation range $150,000-$300,000. CareSource takes into consideration a combination of a candidate&rsquo;s education, training, and experience as well as the position&rsquo;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&rsquo;s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies<ul><li>
Fostering a Collaborative Workplace Culture
</li><li>Cultivate Partnerships</li><li>
Develop Self and Others</li><li>
Drive Execution</li><li>
Energize and Inspire the Organization</li><li>
Influence Others</li><li>
Pursue Personal Excellence</li><li>
Understand the Business</li></ul><h2 class="jobSectionHeader"> 
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.</h2>
#LI-SW2 

Brand=CareSource</div>

AVP, Actuarial Science (Medicaid)

<div>Job Summary: 
 
The Onboarding Specialist is the primary contact for members as they transition to a CCA/CareSource health plan. The Specialist contacts new members via telephonic outreach and identifies both the member's existing healthcare services that will continue and new service requests. The Specialist works to ensure that member needs are addressed through liaising with internal CCA/CareSource providers and external healthcare providers. The Specialist also educates the member on health plan offerings and addresses members' questions or concerns. 
 
Essential Functions:<ul><li>
Serves as the primary member contact and advocate until their care team is established, both through direct member outreach and inbound call support</li><li>
Leverages internal and external resources (such as claims, referrals, and pharmacy data) to identify accurate, successful contact information for unreachable or hard-to-reach members</li><li>
Orients new members to the value of CCA/CareSource as their health plan, providing education, answering members&rsquo; questions, anticipating, and meeting member needs and concerns</li><li>
Documents members&rsquo; current healthcare services and new service requests</li><li>
Ensures members continue to receive current healthcare services as they transition to CCA/CareSource through healthcare provider outreach and education</li><li>
Schedules new members&rsquo; initial nurse intake visits</li><li>
Utilizes communication skills such as motivational interviewing to gain agreement from members to participate in the onboarding process, persistently forging trusting relationships and engaging individuals not readily interested in connecting with CCA/CareSource</li><li>
Utilizes established workflows and collaborates with internal and external stakeholders and healthcare providers</li><li>
Provide clinical care to members via telehealth technologies (video, chat, etc.) for a clinically appropriate clinical care and care management services.</li><li>
Perform any other job related duties as requested.</li></ul> 
Education and Experience:<ul><li>
Bachelor's Degree or relevant experience in call center and/or Medicare/Medicaid plan required</li><li>
Equivalent years of relevant work experience may be accepted in lieu of required education</li><li>
Five (5) years of relevant experience required</li><li>
One (1) year working in outreach or in the community with individuals who have behavioral, medical, social, or interpersonal complexities impacting their lives required</li><li>
Experience working in a multi-cultural setting required</li><li>
Experience using motivational interviewing techniques in a professional setting required</li><li>
Experience identifying unmet healthcare needs and escalating to the appropriate individual preferred preferred</li><li>
Experience with electronic medical record and care management systems strongly preferred preferred</li></ul>
Competencies, Knowledge and Skills:<ul><li>
Demonstrated understanding of the community served</li><li>
Familiarity with data entry and querying databases to identify key information about members</li><li>
Excellent communication skills, including the ability to convey information clearly telephonically and in a culturally sensitive manner</li><li>
Strong interpersonal and customer relation skills, including active listening skills, dependability, and responsiveness</li><li>
Compassionate, understanding, and patience</li><li>
Motivates, empowers, inspires, and collaborates with members while effectively establishing boundaries by clarifying roles, expectations, and deliverables</li><li>
Ability to develop and maintain positive working relationships with peers, supervisors, and other organizations</li><li>
Knowledge of some medical terminology preferred</li><li>
Ability to multitask and ensure all work is completed thoroughly and completely in a fast-paced environment with competing demands</li><li>
Basic computer skills</li><li>
Professional, comprehensive, clear documentation</li><li>
Familiarity with Microsoft Office programs: Outlook, Calendar, Word</li><li>
Willing to learn and utilize telehealth technologies (video, chat, etc.), when appropriate, for a variety of clinical care and care management services.</li></ul>
Licensure and Certification:<ul><li>
None</li></ul>
Working Conditions:<ul><li>
General office environment; may be required to sit or stand for extended periods of time</li><li>
Travel is not typically required</li></ul>
Compensation Range:
$47,400.00 - $76,000.00
CareSource takes into consideration a combination of a candidate&rsquo;s education, training, and experience as well as the position&rsquo;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&rsquo;s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Hourly
Organization Level Competencies
<ul><li>Fostering a Collaborative Workplace Culture</li><li>
Cultivate Partnerships</li><li>
Develop Self and Others</li><li>
Drive Execution</li><li>
Influence Others</li><li>
Pursue Personal Excellence</li><li>
Understand the Business</li></ul><h2 class="jobSectionHeader"> 
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.</h2> 

Brand=Commonwealth Care Alliance</div>

Remote - Onboarding Specialist

Join CareSource and explore 2   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

CareSource

About Company

AVP, Actuarial Science (Medicaid)

Remote - Onboarding Specialist