Job Search
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Tulsa, OK, USA ● Req #651Tuesday, December 3, 2024JOB SUMMARY: The Behavioral Health Clinical Specialist (therapist) is an essential part of our behavioral health team and organization. This licensed behavioral health clinician will be instrumental in ensuring the appropriate utilization of behavioral health services for our members while upholding the highest standards of care and efficiency. This clinician will be responsible for clinical review and assessment of care for mental health and substance abuse services for the health plan. As wel ...Read more about Behavioral Health - Behavioral Health Clinical Specialist (LPC/LCSW) 150-2005More
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Tulsa, OK, USA ● Req #718Wednesday, November 27, 2024JOB SUMMARY: The Medical Director will exhibit strong expertise in utilization management and health plan leadership for our provider sponsored organization. They will have a proven track record working within a health plan environment, with a deep understanding of clinical operations, healthcare utilization, and strategies for controlling healthcare costs while maintaining high-quality care. This key role within our Clinical Operations team is pivotal in optimizing the efficiency and effectiven ...Read more about Medical Management - Medical Director 145-7004More
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Tulsa, OK, USA ● Req #704Monday, November 25, 2024JOB SUMMARY: Responsible for being the first point of contact for all membership related questions, requests and concerns and for providing outstanding service to our customers. You will answer queries regarding customer benefits, eligibility, PCPs, claims and other questions. You will handle complaints, troubleshoot problems and provide resolutions in a professional and polite manner to ensure first contact resolution and customer satisfaction. The ideal Customer Service Representative will ...Read more about Customer Service - Customer Service Representative 105-1065More
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Tulsa, OK, USA ● Req #672Monday, November 25, 2024JOB SUMMARY: Responsible for being the first point of contact for all membership related questions, requests and concerns and for providing outstanding service to our customers. You will answer queries regarding customer benefits, eligibility, PCPs, claims and other questions. You will handle complaints, troubleshoot problems and provide resolutions in a professional and polite manner to ensure first contact resolution and customer satisfaction. The ideal Customer Service Representative will ...Read more about Customer Service - Customer Service Representative 105-1020More
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Tulsa, OK, USA ● Req #699Monday, November 25, 2024JOB SUMMARY: Responsible for auditing provider and facility claims against relevant medical records and documents. Audits verify coding accuracy, benefit payment, contract interpretation, and overall compliance with established guidelines and standards. Participates in various projects aimed at identifying areas of non-compliance and/or potential fraud, waste and abuse, as it relates to coding and provider billing practices. KEY RESPONSIBILITIES: Identifies areas of potential non-compliance a ...Read more about Medical Management - Certified Medical Review Examiner 145-2001More
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Tulsa, OK, USA ● Req #708Monday, November 25, 2024JOB SUMMARY: Responsible for providing customer service support for behavioral health benefits, directing members to appropriate in network services, processing prior authorizations according to CMS and State regulations, sending out provider faxes well as member letters, and resolving behavioral health related situations that arise from calls. KEY RESPONSIBILITIES: Available and able to be telephone support part time during the hours of 8AM -5PM except for lunch and breaks to support behavior ...Read more about Behavioral Health - Intake Specialist (Part Time) 150-1006More
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Tulsa, OK, USA ● Req #714Thursday, November 21, 2024JOB SUMMARY: Responsible for leading and managing projects from planning through completion to support the organization’s strategic objectives. The role includes overseeing project milestones, managing schedules, and analyzing data to ensure successful project outcomes. Works closely with both business and IT stakeholders to address requirements, monitor progress, and provide updates, ensuring projects meet quality standards and are delivered on time. Facilitates meetings and coordinates with cr ...Read more about Project Management Operations - Project Manager 141-2004More
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Tulsa, OK, USA ● Req #716Thursday, November 21, 2024JOB SUMMARY: The Stars Medication Adherence Specialist implements, tracks and supports new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of programs for providers and members in accordance with prescribed quality standards; conducts data collection, tracking and monitoring for key performance measurement activities at the provider and member level. Provides ongoing practice support and sustains the partnership. Improves the understanding and ...Read more about Quality Improvement - STARS Medication Adherence Specialist 195-1031More
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Tulsa, OK, USA ● Req #668Thursday, November 21, 2024JOB SUMMARY: As a Financial Analyst specializing in modeling and process improvement, you will play a critical role in enhancing financial performance and operational efficiency within the organization. Your primary responsibilities will revolve around financial modeling, analysis, and the implementation of process improvements to drive strategic decision-making and optimizebusiness processes. KEY RESPONSIBILITIES: Financial Modeling: Develop and maintaincomplex financial models to an ...Read more about Financial Planning & Analysis - Financial Analyst 127-2004More
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Tulsa, OK, USA ● Req #647Tuesday, November 12, 2024JOB SUMMARY: The Medical Review Supervisor is responsible for overseeing activities and personnel involved in the day to day operations of CommunityCare’s medical claim review program. The supervisor guides individuals in implementing auditing and monitoring functions aimed at identifying areas of risk and/or potential fraud, waste and abuse, as it relates to provider billing practices. KEY RESPONSIBILITIES: Provides technical expertise to MRE staff including analysis, problem solving, an ...Read more about Medical Management - Supervisor Medical Review 145-4005More
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Tulsa, OK, USA ● Req #705Tuesday, November 12, 2024JOB SUMMARY: Responsible for managing the operational and strategic aspects of the Company's Quality Improvement department, which includes the QI Program, Star Rating Program, Accreditation, and Clinical Coding and Compliance monitoring. KEY RESPONSIBILITIES: Leads and directs processes and overall quality improvement activities for all beneficiaries. Responsible for multiple company work domains, including but not limited to: Quality Improvement activities and interventions - Coordinates a ...Read more about Quality Improvement - Senior Manager Quality Improvement 195-6000More
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JOB SUMMARY: The Claims Examiner is responsible for examining claims that require review prior to being adjudicated. The examiner will use their resources, knowledge and decision-making acumen to determine the appropriate actions to pay, deny or adjust the claim. Examiners are expected to meet performance expectations in accuracy and efficiency. KEY RESPONSIBILITIES: Examining and adjudicating claims that have pended for review utilizing resources, tools, knowledge and decision-making i ...Read more about Claims HMO - Claims Examiner 140-1008More
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Tulsa, OK, USA ● Req #641Monday, November 4, 2024JOB SUMMARY: Responsible for supervising credentialing personnel and oversight of training. Supervise workflows and projects to support timely, efficient production. Responsible for ensuring credentialing policies and procedures are compliant with regulatory agencies and accreditation standards. KEY RESPONSIBILITIES: Provide day-to-day supervision of personnel. Evaluate performance of direct reports and provide regular feedback individually and to the team.Identify improvement opportunities t ...Read more about Provider Services - Supervisor Credentialing 115-4004More
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JOB SUMMARY: The Analyst II provides analytical support for all departments, including analysis, pricing, capitation, network and provider specific reporting. Analytical support includes creating and executing intermediate to advanced level reports and programs and programming modifications to previously written reports. The Analyst II will collaborate with key stakeholders and determine the needed result including any special specifications. The Analyst II will work with several databases to p ...Read more about Reporting - Health Data Analyst II 135-2010More
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Tulsa, OK, USA ● Req #695Monday, November 4, 2024JOB SUMMARY: Responsible for providing daily guidance, instruction and training to inspire the team to perform at their optimum. Will work directly with Customer Service Supervisor to create a team that works efficiently together to maximize the team’s potential. Also responsible for interacting with members, providers and other internal customers to resolve elevated problems of a complex nature. May serve as a liaison between Customer Service and other departments. Assists Customer Service ...Read more about Customer Service - Customer Service Team Lead 105-1027More
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Tulsa, OK, USA ● Req #694Monday, November 4, 2024JOB SUMMARY: Oversees the day-to-day operations within the Internal Audit department and supervises the department's internal audit staff. Works with staff to develop testing and auditing methodologies for use when evaluating the company's compliance with regulatory requirements and adequacy of internal controls. Works with the Compliance & Risk Officer to coordinate external audits by regulators as needed. Performs special projects assigned by the Compliance & Risk Officer and/or Internal Audi ...Read more about Internal Audit - Supervisor Internal Audit 122-2009More
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Tulsa, OK, USA ● Req #681Monday, November 4, 2024JOB SUMMARY: Responsible for completing out-bound calls and other member outreach opportunities to select members and documenting efforts. This role spends 100% of time on quality program activities. May require extended, or multiple, phone calls to members. May require work on additional projects as directed. KEY RESPONSIBILITIES: Contact members selected for intervention. Assist members with developing a plan to resolve identified HEDIS gaps in care, setting up appointments, getting to ...Read more about Quality Improvement - Member Engagement Specialist 195-1017More
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Tulsa, OK, USA ● Req #638Saturday, October 26, 2024JOB SUMMARY: The Software Engineer will build out the next generation of our platform. As a Software Engineer, you are expected to work independently, and within teams, leading the development of software features. You will be involved with the early stages of mentoring other team members and helping with identifying process improvements for the team. KEY RESPONSIBILITIES: •Implements features of the application and is proficient in one or more of the feature or components. •Leads independent ...Read more about Information Technology - Software Engineer 130-2048More
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JOB SUMMARY: Responsible for providing customer service support for behavioral health benefits, directing members to appropriate in network services, processing prior authorizations according to CMS and State regulations, sending out provider faxes well as member letters, and resolving behavioral health related situations that arise from calls. KEY RESPONSIBILITIES: Available and able to be telephone support from 8AM -5PM except for lunch and breaks to support behavioral health needs for all l ...Read more about Behavioral Health - Intake Specialist 150-1005More
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JOB SUMMARY: The Senior Health Data Analyst provides the analytical support for Executives and all departments including analysis, pricing, capitation, network, and provider specific reporting. Analytical support includes programming customer-based specifications, producing appropriate statistics, reports, and presentations, analyzing results and impacts, and generating written reports with recommendations and conclusions. The Senior Analyst works with data in company and other databases, data ...Read more about Reporting - Senior Health Data Analyst 135-2031More
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JOB SUMMARY: The Senior Health Data Analyst provides the analytical support for Executives and all departments including analysis, pricing, capitation, network, and provider specific reporting. Analytical support includes programming customer-based specifications, producing appropriate statistics, reports, and presentations, analyzing results and impacts, and generating written reports with recommendations and conclusions. The Senior Analyst works with data in company and other databases, data ...Read more about Reporting - Senior Health Data Analyst 135-2030More
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Tulsa, OK, USA ● Req #658Sunday, October 20, 2024JOB SUMMARY: The Software Engineer will build out the next generation of our platform. As a Software Engineer, you are expected to work independently, and within teams, leading the development of software features. You will be involved with the early stages of mentoring other team members and helping with identifying process improvements for the team. KEY RESPONSIBILITIES: •Implements features of the application and is proficient in one or more of the feature or components. •Leads independent ...Read more about Information Technology - Software Engineer 130-2058More
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Tulsa, OK, USA ● Req #656Sunday, October 20, 2024JOB SUMMARY: The Software Engineer will build out the next generation of our platform. As a Software Engineer, you are expected to work independently, and within teams, leading the development of software features. You will be involved with the early stages of mentoring other team members and helping with identifying process improvements for the team. KEY RESPONSIBILITIES: •Implements features of the application and is proficient in one or more of the feature or components. •Leads independent ...Read more about Information Technology - Software Engineer 130-2057More
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Tulsa, OK, USA ● Req #668Thursday, October 17, 2024JOB SUMMARY: As a Financial Analyst specializing in modeling and process improvement, you will play a critical role in enhancing financial performance and operational efficiency within the organization. Your primary responsibilities will revolve around financial modeling, analysis, and the implementation of process improvements to drive strategic decision-making and optimizebusiness processes. KEY RESPONSIBILITIES: Financial Modeling: Develop and maintaincomplex financial models to an ...Read more about Financial Planning & Analysis - Financial Analyst 127-2004More
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Tulsa, OK, USA ● Req #679Thursday, October 17, 2024JOB SUMMARY: Responsible for being the first point of contact for all membership related questions, requests and concerns and for providing outstanding service to our customers. You will answer queries regarding customer benefits, eligibility, PCPs, claims and other questions. You will handle complaints, troubleshoot problems and provide resolutions in a professional and polite manner to ensure first contact resolution and customer satisfaction. The ideal Customer Service Representative will ...Read more about Customer Service - Customer Service Representative (Part Time) 105-1070More