Careers

• Claims
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    Claims, Quality Assurance Specialist
    Location: Bluffton, SC
    Description: A successful candidate will be responsible for completing and testing of all applicable incoming and outgoing data files, new and changed configurations, new implementations, new and changed system modifications and provide Intra-Department support on testing and trouble shooting new and existing mapping configuration.
    Requirements: High school graduate or equivalent, basic knowledge of CMS 1500 and UB04 claim forms, knowledge of CPT and ICD-9 codes, proficient use of PC and other business machines, ability to follow oral and written policies and workflows, good written and oral communication skills, attention to detail and strong pride in work completed.
    To Apply: Email careers@carecorenational.com with subject: Claims Specialist
    
    
    
• Clinical Services
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    Clinical Appeals Supervisor
    Location: Bluffton, SC
    Description: Responsible for daily management of the Reconsideration/Appeals department. Will act as a liaison for the medical directors and the pre-certification departments on projects to improve ICMU efficiency and compliance. Maintain knowledge of policies and procedures of clinical certification and medical review, as well as the policies of contracted health plans and client organizations for CareCore National.
    Requirements: Senior Registered Nurse, currently licensed. Clinical and managed care experience required. Knowledge of industry regulatory requirements and the principles and procedures of utilization management. Strong communication and analytical skills are essential.
    To Apply: Email careers@carecorenational.com with subject: Clinical Appeals Supervisor
    
    
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    Clinical Decision Support Supervisor
    Location: Bluffton, SC
    Description: The Clinical Decision Support Supervisor oversees and coordinates the day-to-day operations of the Clinical Decision Support Unit and works collaboratively with the Vice President of Clinical Services and other supervisors to facilitate the notification processes for radiology services
    Requirements: Registered Professional Nurse or LPN strongly preferred, Minimum 1 year Clinical experience preferred, At least 2 years previous supervisory or managed care experience with a knowledge of industry regulatory requirements, ability to independently evaluate and analyze related information in order to plan, develop, and monitor notification activities to meet program goals and objectives, strong communication skills, basic computer skills, including Excel and Word, knowledge of basic adult learning skills.
    Responsibilities: Supervise Clinical Decision Support team in processing of telephonic or written clinical notification requests for radiological services from physician offices and/or imaging centers in accordance with contractual obligations, develop and maintain knowledge of CareCore Radiology policies and procedures and scripted pathways related to clinical notification processes, monitor decision support team to assure that scripted pathways are effectively and objectively applied and ensures clinical notification services are compliant with CareCore and contractually defined industry standards, maintain data necessary to manage the Clinical Decision Support staff, including statistical reporting, quality audits and proficiency testing results, document and report notification review activities to the Chief Medical Officer and the appropriate CareCore Committees, conduct at minimum quarterly staff meetings with all Clinical Decision Support staff in their reporting area, document and report follow-up of concerns and complaints regarding Clinical Decision Support staff, assist in the development and implementation of the annual QM and UM plan and yearly evaluation of process manuals, coordinate completion of performance evaluations for team members with the assistance of auditors, assist in completion of quarterly audits of Clinical Decision Support activity, maintain knowledge of URAC and NCQA principles, policies, and procedures, maintain the confidentiality of patient information in accordance with HIPPA and other regulatory requirements, provide the lead in motivating team members in notification process to perform at the highest level possible and provide quality customer service, assist in completion of appropriate training modules for new and existing Clinical Decision Support staff.
    To Apply: Email careers@carecorenational.com with subject: Clinical Decision Support Supervisor
    
    
  • Medical Director, Cardiology
    Location: Work remotely, from home, or in the Bluffton, SC office
    Description:We are seeking a board-certified cardiologist to provide medical evaluation of provider preauthorization requests. This position is full time with an option to work remotely from home.
    Requirements: Candidate must be board certified with an unrestricted license. A background in electrophysiology is preferred but not required.
    To Apply: Email careers@carecorenational.com with subject: Medical Director, Cardiology
    
    
  • Medical Directors - Board Certified
    Location: Work remotely, from home, or in the Bluffton, SC office
    Description: Evaluate medical necessity requests for imaging services that do not meet utilization review criteria.
    Requirements: Board certified in area of specialty with a valid license to practice in the United States without restriction as a doctor of medicine or doctor of osteopathic medicine.
    To Apply: Email careers@carecorenational.com with subject: Medical Director
    
    
  • Sr. Medical Director – Radiology Benefits Management
    Location: Bluffton, SC
    Description: We are seeking a board-certified radiologist to serve as Sr. Medical Director for CareCore Radiology Services. This position is full time and is located in our Bluffton, SC office, midway between Savannah, GA and Hilton Head, SC. In this position, you will work under the direction of the Chief Medical Officer to coordinate all clinical aspects of utilization and quality management activities for CareCore Radiology Services.
    Requirements: Candidate must be board certified with an unrestricted license. Previous supervisory/management experience is required, managed care experience strongly preferred.
    To Apply: Email a CV to careers@carecorenational.com with subject: Sr. Medical Director
    
    
• Information Technology
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    Jr. and Sr. Database Administrators
    Location: Bluffton, SC
    Description: We are seeking Database Administrators to support our growing Information Technology needs. All positions are located in our corporate headquarters, midway between Savannah, Georgia and Hilton Head, South Carolina. In this position, you will be part of a team that designs, implements, and maintains a major modification to an in-house SQL Server/.Net application. Schema design, stored procedures, views, and performance-tuning functions will be required on an ongoing basis.
    Requirements: The successful senior-level candidate will possess a bachelor’s degree or the equivalent, with a minimum 5 years experience with Microsoft SQL Server; junior-level candidates must meet the same educational requirements with a minimum 3 years experience. Thorough understanding of T-SQL programming and Windows Server operating systems is required. Expertise in schema design, implementation, and enhancement is also required. Experience with the following is preferred: Medical/insurance data, Reporting Services, SQL Server Integration Service, and EMC/SAN Storage.
    To Apply: Email careers@carecorenational.com with subject: Database Administrator
    
    
  • Help Desk Technician – MCDST Certified
    Location: Bluffton, SC
    Description: Provide in-house and remote end user support for LAN of 700+ Windows XP Pro baseddesktops and thin clients. Work help desk tickets and maintain help desk system. Maintain documentation of problems found, identify and report potential problems and trends. Assist the System Administrator with maintaining daily operational functionality of the company's systems as required. Multiple shift positions available.
    Requirements: MCDST or higher certification required as well as Mac support experience OS-X. Must have excellent oral and written communications skills. Must be customer oriented, and able to deal with deadlines. Experience with Norton Ghost, Right Fax, and Active Directory is a plus.
    To Apply: Email careers@carecorenational.com with subject: Help Desk Technician
    
    
  • QA Analyst
    Location: Bluffton, SC
    Description: Responsible for creating and executing test scripts through the testing process. The Quality Assurance Analyst will work closely with the development team to complete all testing activities, establish processes and improve quality and efficiency. Interact with developers and management while building requirements documentation. Understand and document key IT solutions such as Document Generation facility.
    Requirements: Associates or Bachelors degree in Information Systems, Computer Science, or equivalent experience. Experience with automated and manual testing required. Knowledge of healthcare processes, functions and data. Successful candidate must have strong interpersonal skills both written and oral. Attention to detail. Experience in software testing as an end user (UAT) or internal member of IT development function preferred. Experience with SQL and Scripting desired.
    To Apply: Email careers@carecorenational.com with subject: QA Analyst
    
    
  • Quality Assurance Manager
    Location: Bluffton, SC
    Description: In this position, you’ll set the strategy, goals, and vision for the QA Department, and be responsible for daily oversight and support for a team of QA testers. The ultimate goal is to ensure timely, efficient, and accurate delivery of code, and to drive efforts to improve software test design, coverage and execution.
    Requirements: The successful candidate will have a Bachelors Degree in Computer Science, Business Administration, or related field with 5+ years of hand-on software testing experience, including the development of test plans, test cases, and scripts. A minimum of 3 years managing a QA team is required, as is experience with software testing and defect tracking tools. Experience with evaluating and implementing testing automation tools is preferred, as is experience with MS Team Foundation Server. Software Quality Testing certification from a recognized certified body is also a plus.
    To Apply: Email careers@carecorenational.com with subject: Quality Assurance Manager
    
    
  • Software Engineer
    Location: Bluffton, SC
    Description: Develop and implement custom software solutions in support of the organizations ongoing business operations and new product offerings. Responsibilities include: Analyze and confirm understanding of functional requirements as defined by organization, develop and deliver software solutions for internal users or external clients in accordance with organizational standards and project delivery timelines and develop maintenance and emergency break/fix software solutions to support ongoing operations.
    Requirements: College degree and a minimum 3 - 5 years of software development experience for highvolume transactional applications. Proven expertise in web based development and software design is required; solid working knowledge of .Net, ASP, VB.net, Java, SQL Server. Demonstrated ability to work in a large team or on an individual basis to create robust software solutions. Healthcare industry or experience integrating telephony applications is a plus; as are certifications such as MCAD.
    To Apply: Email careers@carecorenational.com with subject: Software Engineer
    
    
  • ETL/SQL Developer
    Location: Bluffton, SC
    Description: As part of the Database Services team the SQL Developer will design and implement complex SQL Server 2005/2008 databases and SQL Server Integration Services Packages to ensure effective performance and availability service levels. The SQL Developer will regularly interact with peers in Database Services and Application Development. A successful candidate will be responsible for design, develop and implement database designs from the ground up to stage, modify and load data received from various sources, develop and maintain DTS/SSIS packages for ETL tasks and develop SQL scripts to process and deliver information.
    Requirements: The successful candidate will have 5+ years experience with Microsoft SQL Server, 2+ years experience with ETL processes using SSIS and DTS, thorough knowledge with Transact-SQL programming, experience designing and implementing small and very large databases and data warehousing, strong understanding of DBA concepts, .NET technologies and programming and up to date3 on the latest database technologies, practices and procedures.
    To Apply: Email careers@carecorenational.com with subject: ETL/SQL Developer
    
    
  • Systems Administrator
    Location: Bluffton, SC
    Description: In this position, you’ll maintain operational functionality of the company’s host and network infrastructure as required to staff ongoing operations. Responsibilities include installing and documenting new systems/network equipment in accordance with designed specifications, maintain network and server environments in accordance with corporate policies and procedures, document system changes, assist on consultative basis and act to resolve operational support issues for Help Desk function, maintain and respond to system monitoring alerts or outages based on schedule set forth by department manager.
    Requirements: The successful candidate will have a college degree and a minimum 5 years of system administration experience in a large organization (500+ employees; 100+ servers and networking equipment). Proven technical skills/accomplishments and certifications. Demonstrated ability to clearly communicate status and resolve issues to completion independently or as part of a group. Desired certification levels include: CCNA through CCSP or MCSA/MCSE. Experience with the following are a plus: EMC SAN/NAS, Cisco switches & routers, SSL/VPNs, load balancing (Radware), VoIP, IBM AS400, Microsoft clustering, WSUS, Citrix, VMCenter/VSphere, etc.
    To Apply: Email careers@carecorenational.com with subject: System Administrator
    
    
• Program Operations
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    Program Leader
    Location: Bluffton, SC
    Description: Responsible for oversight of CareCore National programs, analysis of related business processes, and recommendations for business process improvement. Serves as the interface between senior management and IT resources to develop application solutions to support business processes.
    Requirements: Significant project management experience with a focus on IT application development processes; health care management experience is a plus. Understanding of business processes and data analytics is preferred. Candidate must possess excellent verbal and written communication skills, organizational skills, and an ability to work collaboratively across the organization.
    To Apply: Email careers@carecorenational.com with subject: Program Leader
    
    
    
• Data Analytics
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    Healthcare Medical Economist
    Location: Bluffton, SC
    Description: Responsible for managing all data analysis processes supporting new contract pricing, existing client utilization management, referring and rendering provider profiling and other reporting requirements critical to contract compliance. The Manager of CareCore’s Data Analytics team is responsible for providing leadership and guidance to the data analytics team in their use, manipulation and understanding of CareCore’s transactional data.
    Requirements: Minimum of 3-5 years of experience in data analysis and/or technical knowledge; a Bachelor’s degree in Computer Science, Mathematics, Finance or a related field; and Advanced skills in MS Access, Word, Excel, and SQL. Excellent written and verbal skills required; managed care or other healthcare industry experience required. Demonstrated success in leading small teams is also required.
    To Apply: Email careers@carecorenational.com with subject: Data Analytics Manager
    
    
    
• Other
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    Manager, Provider Contracting Services
    Location: Bluffton, SC
    Description: The Manager of Provider Contracting Services is responsible for overseeing all of the activities of the network management process for each of our products; these include but are not limited to outpatient radiology, radiation therapy, pain management, medical oncology, lab and sleep management. The day to day responsibilities include oversight of the contracting processes, fee schedule management, electronic directories, management of the databases, file management (requests for participation, accreditation documents, quality audits, etc), reporting to internal and external customers, staff management and the development of policies and procedures necessary for assuring regulatory compliance and development of efficient procedural processes in a fast paced dynamic environment.
    Requirements: The successful candidate will have a Bachelor’s Degree in Business or Health Services Administration and/or equivalent work experience. Excellent organizational, analytical, communication and presentation skills are required. Proficiency in Microsoft Office software is a must. Previous managed care experience is desirable but not required.
    To Apply: Email careers@carecorenational.com with subject: Manager, Providing Contracting Services
    
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    Claims Auditor
    Location: Bluffton, SC
    Description: Responsible for investigating identified problems in our claims processing systems as well as our eligibility files, and to collaborate with others in developing recommendations to solve them. Conduct internal audits for the claims processing system as well as the claims processors
    Requirements: A Bachelor’s Degree preferably in Accounting and/or related field. A minimum of one to three years’ health claims experience. The ideal candidate will be well organized, detail oriented, understand system concepts, have strong oral and written communication skills, be able to lead in group collaboration efforts and be able to investigate problems diplomatically.
    To Apply: Email careers@carecorenational.com with subject: Claims Auditor
    
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    Senior Analyst
    Location: Bluffton, SC
    Description: We are looking for a candidate to create, maintain and execute Transact SQL queries in Microsoft SQL Server Management Studio for ad hoc and standard reporting. In this position, you will be responsible for providing cost savings analysis for new and existing products. This process includes raw data loads, cleansing, customization and analysis in an Oracle SQL environment using TOAD. The ideal candidate will be able to adapt to new software and coding environments as well as communicate well with multiple internal and external departments to establish project requirements, validate coding logic and resolve data issues.
    Requirements: The successful candidate will have a minimum of 5 years of experience in Healthcare data analysis and/or technical knowledge; a Bachelors Degree in Business or Health Services Administration, Computer Science or related field, and advanced skills in SQL, MS Access, Word, and Excel. Excellent written and verbal skills required; managed care experience preferred.
    To Apply: Email careers@carecorenational.com with subject: Senior Analyst
    
  
  
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    Sr. Account Manager
    Location: Bluffton, SC
    Description: We are looking for a seasoned professional to lead a team responsible for managing the relationships associated with new and existing clients. In this position, you’ll work across the organization to support contract implementation, address and resolve issues, manage contract compliance, and manage the overall relationship of CareCore National with one or more of its major health plans. The ideal candidate will have demonstrated the appropriate leadership, organizational, and technical expertise associated with success in a fast-moving, dynamic environment.
    Requirements: The successful candidate will have a Bachelors Degree in Business or Health Services Administration and/or equivalent work experience. Excellent organizational, analytical, communication, and presentation skills are required. Proficiency in Microsoft Office software is a must. Previous managed care experience is desirable but not required.
    To Apply: Email careers@carecorenational.com with subject: Sr. Account Manager
    
  
  
  
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• Download PDF - Updated 9/01/2010