CareSource

• Oversee function operations through proactive monitoring of contract volumes, contract turnaround times, process adherence, and value delivered • Oversee the vendor contract portfolio, ensuring timely action against expiring contracts, strategic planning and engagement with business owners • Deliver value to the enterprise by leveraging benchmarking, negotiations, and category management to deliver savings, increased vendor accountability, vendor consolidation • Drive Strategic Sourcing strategy via a comprehensive category management model • Conduct and lead category councils with key business owners to strategize on obtaining competitive pricing, securing favorable contract terms, and fostering robust vendor partnerships • Standardize and enhance the function’s processes including due diligence and vendor selection processes • Enhance and increase utilization of RFx processes, including Requests for Proposal (RFP) • Manage and streamline the contracting process across a diverse and extensive vendor base • Proactively engage with other departments, including third party risk, vendor risk, legal, compliance, and finance • Facilitate the state approval process for contracts

• The Manager, Utilization Management (UM) Strategy & Implementation leads a dedicated team that supports the UM program through multiple functions with a focus on all regulatory and compliance functions. • Oversee and manage UM Operations oversight functions such as Corrective Action Plan (CAP) management, ongoing monitoring, and multiple audit activities. • Build and leverage effective cross-functional business relationships and influence action across multiple internal and external partners to support a culture of compliance. • Responsible for development and maintenance of documentation related to policy, workflow and process when applicable. • Identify process gaps and drive improvements towards UM compliance in all areas.

• Provides financial oversight, leadership, and support to the market/corporate • Manages the execution of the annual budget/quarterly forecast • Works with senior management and team to implement new business activities and process improvements • Develops strategy supporting the FP&A function • Responsible for budget to actual analysis monthly • Provides support for proforma work related to RFPs, mergers, and acquisitions for new business activities • Responsible for end-to-end planning process including project management oversight • Responsible for contract reviews for administrative costs • Guides and oversees the process for compilation of data and reporting • Provides insight into the risk sensitivity associated with current and future business drivers • Responsible for ensuring budget policy and procedures are in compliance with Model Audit Rule requirements • Participates in various meetings with leadership including strategic planning • Performs ad hoc and trending analysis • Responsible for staffing decisions, management of departmental staff and expense budget

• Responsible for oversight of all Clinical Pharmacy activities ensuring consistency in delivery of services and achievement of utilization targets • Assist in coordination and management of the pre-determination process for specialty pharmacy • Assist in the development of integrated service delivery to members and oversee data and processes to maintain industry standards and practices • Assist the Director in developing processes to manage appropriate utilization and assure appropriate payment for services • Interact with providers and staff to manage benefits aligned with regulations, URAC and NCQA regulations and CareSource policies and vision • Review and revise workflows to maximize efficiencies • Monitor productivity and utilization trends • Oversee CQI activities and ensure audits and staff feedback occur at regular intervals • Regularly report all specialty pharmacy data • Ensure compliance with and reporting of all regulatory requirements • Analyze and formulate recommendations based on data • Maintain and update all departmental policies and procedures • Act as liaison with other departments to assist with research and intervention • Empower staff to achieve goals • Coach, develop, and motivate team • Foster positive working relationships with internal departments and external providers • Perform any other job related instructions as requested

• Extracting, analyzing, reporting, tracking and monitoring provider data across business functions, systems and interfaces • Support existing provider data operations and new market implementations • Perform disruption analysis activities for assigned markets • Serve as Project Manager for select HPLC initiatives • Develop Performance Improvement initiatives and corrective action plans to improve quality of provider data • Coordinate activities with regard to provider network data management and reporting • Develop database structures and reports as needed • Review provider organizations and systems for analyses that support contract negotiation and provider recruitment processes

Role Description The Manager, Information Technology is responsible for working closely with customers, business partners, project managers, and team members to understand business requirements that drive the analysis and design of quality solutions that are aligned with business and IT strategies and comply with the organization’s architectural standards. - Manage a team of Information Technology professionals - Provide leadership, vision, management goals, priorities, metrics, measures, recognition and discipline - Responsible for the relationship between key business stakeholders and IT and accountable for the team’s delivery of the associated business services - Set vision and direction of department - Responsible for the team’s execution of assigned work - Develop strategy and high-level implementation plans for the delivery of new technology - Evaluate, validate, and communicate the business proposition associated with new technology initiatives - Improve solution functionality and efficiency with added business value as the goal - Liaise closely with other business areas to optimize the use of systems and applications - Systematically evaluate currently deployed services; develop and manage plans to optimize delivery and support mechanisms - Regularly assess the associated technology platforms to ensure that the platforms meet the required standards for reliability, availability, security, cost and performance, business value justification, regulatory compliance, and architecture - Develop, document, and maintain short and long term plans - Foster relationship management through communication to key business stakeholders - Focus on business decisions required by technology, development status, problems and issues, project status and success - Develop technical, project management and leadership skills of IT professionals - Represent IT in project and/or business meeting and engagements - Participate in conference calls or visits with vendors/third parties - Introduce new customers to IT services and assist in familiarizing them with appropriate systems, services, policies, and procedures - Participate in departmental meetings/activities and contribute to a collaborative team environment - Work with staff to set performance goals and objectives - Provide daily supervision and review of work products - Provide feedback on performance on a regular basis - Develop career plans for staff based on their input and team objectives - Lead and provide technical guidance of direct reports - Responsible for managing projects, organizing and directing people and projects - Provide technical guidance, training, and work direction to direct reports - Leverage personnel to develop new programs, systems in relation to assigned responsibilities - Demonstrate logical, systematic approaches and methods - Produce high-quality, functional solutions - Recommend changes or modify solutions as necessary to implement enhancements, resolve production problems, or improve operating efficiency - Coordinate and manage vendor relationships and accountability on project involvement and deliverables - Perform any other job duties as requested Qualifications - Bachelor's degree in Business, Computer Science or related field or equivalent years of relevant work experience is required - Minimum of three (3) years of IT Lead or Management experience is required; successful completion of the CareSource University Individual Contributor Leadership Program may be considered in lieu of experience - Minimum of three (3) years of relevant IT experience is required - Experience translating business requirements into technical specifications is preferred - Technical teaching skills or experience is preferred - Project planning and project management experience is preferred Requirements - Strong learning competency and ability to teach others - Troubleshooting and problem solving capabilities - Project planning skills and abilities IT architecture design and implementation (infrastructure or application development) - Solid project planning and management capabilities - Effective technical programming, analysis, and specification skills - Process and/or workflow planning and design skills - Network protocols and security standards - Ability to use and apply Cisco technologies - Application Development tools and Enterprise Architecture (e.g. TOGAF) - Advanced troubleshooting and problem solving capabilities - Advanced system configuration skills - Proficient in Microsoft technologies (infrastructure or application development) - Strong knowledge of best practices relative to application development or infrastructure standards - Excellent oral and written communication - Ability to manage personal and team time effectively - Effective organization and prioritization - Effective facilitation and interpersonal - Effective management and leadership - Knowledge of the healthcare and managed care philosophy and culture Licensure and Certification - ITIL, MCD, MCSE, CCNE, CISSP, other Infrastructure, Development, or IT Management specific certifications are preferred Working Conditions - General office environment; may be required to sit or stand for extended periods of time 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 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.

Role Description The Team Lead, Integrated Dual Audit will oversee the Integrated Dual Audit team that completes case file reviews to ensure adherence to regulatory requirements and standard operation procedure. - Provide support for Medicare and Medicaid audit preparation. - Collaborate with Quality /Accreditation to support NCQA LTSS requirements. - Develop and manage audit team schedules, workload allocation and productivity metrics. - Provide ongoing training, mentoring, coaching and disciplinary actions for direct reports as needed. - Engage direct reports through consistent performance feedback and development opportunities. - Ensure compliance with adherence to regulatory requirements and identified Standard Operating Procedures (SOPs) through monthly inter-rater reliability monitoring of Auditor team. - Identify training opportunities and work collaboratively with Care Management to develop the needed education and/or training. - Oversee monthly aggregated reporting of audit results. - Serve as subject matter expert (SME) in integrated dual audit processes. - Support Case Management (CM) in interdepartmental meetings/workgroups to ensure that new operational procedures and updates are aligned with contract requirements. - Assist leadership in meeting monitoring, accreditation and operational responsibilities to ensure adherence to regulatory requirements. - Drive continuous improvement efforts by identifying best practices and leading initiatives. - Collaborate with the internal Incident Management program team to support the investigation process related to member health and safety and provide updates to the IM system. - Provide support as needed for the program descriptions/models of care to ensure compliant submissions for the dual products line of business. - Coordinate organizational participation in federal and state contract and regulatory audits and site visits. - Perform any other job related duties as requested. Qualifications - Associates degree required. - Bachelor's degree preferred. - Equivalent years of relevant work experience may be accepted in lieu of required education. - Three (3) years Managed Care experience required. - Two (2) years Audit Experience required. - Previous supervisory experience preferred. Requirements - Intermediate proficiency in Microsoft Excel, Access and Word. - Intermediate skill level with SharePoint. - PowerPoint and Visio knowledge preferred. - Strong written and verbal communication skills. - Ability to work independently and within a team environment. - Familiarity of the healthcare field. - Knowledge of Medicaid and Medicare. - Effective listening and critical thinking skills. - Strong interpersonal skills and high level of professionalism. - Effective problem solving skills with attention to detail. - Ability to develop, prioritize and accomplish goals. Benefits - Compensation Range: $72,200.00 - $115,500.00. - 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. Working Conditions - General office environment; may be required to sit or stand for extended periods of time. - Travel is not typically required. Licensure and Certification - None. 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.

Role Description The Integrated Dual Operational Process Trainer leads the design and delivery of non‑clinical, process‑based training to ensure consistent, compliant execution of LTSS managed care operations. Responsibilities include translating complex LTSS workflows, policies, and regulatory requirements into practical training and tools that drive operational readiness, standardization, and continuous improvement. - Design and maintain end‑to‑end LTSS operational training curricula covering non‑clinical workflows such as intake, eligibility coordination, service authorization support, care coordination processes (non‑clinical), transitions, vendor management, and documentation standards. - Translate LTSS policies, procedures, and regulatory requirements into clear, role‑based training materials, job aids, and process guides. - Develop standardized onboarding and refresher training programs for LTSS operational staff and cross‑functional partners. - Serve as a subject matter expert for LTSS business processes, ensuring training content aligns with approved operating models and enterprise standards. - Partner with program and operations leaders to support process standardization and adoption across markets and products. - Facilitate instructor‑led, virtual, and hybrid training sessions for LTSS operational teams and leadership audiences. - Coordinate training rollout plans for new initiatives, system enhancements, policy changes, or regulatory updates impacting LTSS operations. - Collaborate with Quality, Compliance, and Audit teams to incorporate audit findings, corrective actions, and best practices into training content. - Work closely with LTSS Program Management, Operations, IT, Learning & Development, and Market teams to ensure training aligns with enterprise priorities. - Maintain e-manuals and quick tools to be used as resources for Care Management/Care Coordinator. - Support readiness for new market launches, expansions, or product changes related to LTSS and HCBS programs. - Coordinate with the reporting team to collaborate on trends and reporting triggers within the electronic medical record system. Develop and deliver educational materials as necessary. - Participate in the implementation of new business initiatives relevant to the role. - Identify risk areas within operational processes and contribute to the development of process improvement initiatives. - Perform any other job related duties as requested. Qualifications - Associates degree required - Equivalent years of relevant work experience may be accepted in lieu of required education - Two (2) years Experience in healthcare operations, managed care, Medicaid programs, or LTSS/HCBS environments in a non‑clinical capacity required - Two (2) years Experience in training, development and adult learning environments required - Experience translating policies, procedures, and regulatory requirements into operational workflows, training materials, or job aids preferred - Experience in process improvement, operational excellence, or change management preferred Competencies, Knowledge and Skills - Proficiency in Microsoft Office Suite (Word, Excel and PowerPoint) and clinical documentation systems - Ability to translate staff needs into a diverse range of learning and performance improvement strategies - Excellent written, verbal and public speaking skills - Set, prioritize, and achieve clear, measurable goals while maintaining focus on priorities - Ability to adapt to changing circumstances while driving progress toward established goals - Ability to work independently and collaboratively in a team environment and lead initiatives from concept to implementation - Strong time management, organizational and multitasking abilities - Ability to develop, prioritize and accomplish goals - Build and maintain positive relationships to promote teamwork and facilitate productive discussions - Effective listening, critical thinking, problem-solving skills and attention to detail - Professional interpersonal skills promoting a respectful, inclusive workplace culture - Ability to interact effectively with all levels of management and adapt to multiple organizational layers - Customer service oriented with change resiliency Working Conditions - General office environment; may be required to sit or stand for extended periods of time - May be required to work additional hours and/or outside normal business hours as needed to meet deadlines. - Up to 15% (occasional) travel based on the needs of the department may be required Compensation Range $62,700.00 - $100,400.00. 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 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.

• Conduct both systemic and targeted analysis to identify reimbursement errors and to determine root cause • Collaborate with Configuration, Configuration UAT, Enterprise UAT, IT Claims, and Payment Cycle Team members to ensure test scripts are comprehensive • Provide analytical support and leadership for special projects and initiatives related to reimbursement of claims for both providers and members • Research and provide recommendations to the Reimbursement Committee for reimbursement of services • Research claim results to determine potential errors/discrepancies attributed to clinical edits, claims coding, payment policies, and application of fee schedule and rates • Develop business requirements for payment decisions and manage the implementation process with Configuration, CES, IT and Market stakeholders • Lead special projects to ensure payment discrepancies are resolved and communicated to the appropriate parties • Provide payment expertise at provider meetings, Medicaid Fairs, market workgroups, and any other industry related events • Review and interpret regulatory items and policy manuals to ensure test scenarios support the requirements

• Payment Cycle Analyst IV is responsible for conducting both systemic and targeted analysis to identify reimbursement errors and to determine root cause. • Collaborating with Configuration, Configuration UAT, Enterprise UAT, IT Claims, and Payment Cycle Team members to ensure test scripts are comprehensive. • Proactively collaborates with various teams to support contracting implementations and resolution of complex claims issues. • Validate MCA Tests for expected results and communicate information to Reimbursement Analysts and HP Managers for provider notification. • Create effective written and oral communication materials that summarize findings and support fact-based recommendations