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  • Tulsa, OK, USA ● Req #706
    Friday, December 13, 2024
    JOB SUMMARY: Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high risk members, and other members identified with at risk or high utilization needs. Functions as an active team member of the Utilization Management Team.   KEY RESPONSIBILITIES: Performs utilization review of outpatient and ancillary services as well as inpatient and post-acute service ... More
  • Tulsa, OK, USA ● Req #707
    Friday, December 13, 2024
    JOB SUMMARY: Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high risk members, and other members identified with at risk or high utilization needs. Functions as an active team member of the Utilization Management Team.   KEY RESPONSIBILITIES: Performs utilization review of outpatient and ancillary services as well as inpatient and post-acute service ... More
  • Tulsa, OK, USA ● Req #709
    Friday, December 13, 2024
    JOB SUMMARY: Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high risk members, and other members identified with at risk or high utilization needs. Functions as an active team member of the Utilization Management Team.   KEY RESPONSIBILITIES: Performs utilization review of outpatient and ancillary services as well as inpatient and post-acute service ... More
  • Tulsa, OK, USA ● Req #710
    Friday, December 13, 2024
    JOB SUMMARY: Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high risk members, and other members identified with at risk or high utilization needs. Functions as an active team member of the Concurrent Review Team.   KEY RESPONSIBILITIES: Performs utilization review of inpatient, post-acute, outpatient and ancillary services. Determines medical neces ... More
  • Tulsa, OK, USA ● Req #721
    Friday, December 13, 2024
    JOB SUMMARY: Responsible for helping CommunityCare achieve membership growth targets by meeting or exceeding goal levels for the retention of enrolled groups and members. The incumbent is responsible for establishing positive business relationships with decision makers and decision influencers at enrolled groups, as well as with producers and consultants associated with enrolled groups. Must be willing to learn and grow into roles of increasing responsibility.   KEY RESPONSIBILITIES: Establishi ... More
  • Tulsa, OK, USA ● Req #634
    Friday, December 13, 2024
    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 ... More
  • Tulsa, OK, USA ● Req #703
    Wednesday, December 11, 2024
    JOB SUMMARY: This position is responsible for the training of personnel in the Customer Service and Enrollment departments on procedures, policies, and mode of operations. This job requires someone who is flexible and adaptable to different learning styles, participant needs, and unexpected changes or challenges that may arise during training sessions while remaining motivational to all. Your duties will include performing training needs assessments, designing and delivering curriculum and learn ... More
  • Tulsa, OK, USA ● Req #651
    Tuesday, December 3, 2024
    JOB 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 ... More
  • Tulsa, OK, USA ● Req #718
    Wednesday, November 27, 2024
    JOB 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 ... More
  • Tulsa, OK, USA ● Req #704
    Monday, November 25, 2024
    JOB 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 ... More
  • Tulsa, OK, USA ● Req #672
    Monday, November 25, 2024
    JOB 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 ... More
  • Tulsa, OK, USA ● Req #699
    Monday, November 25, 2024
    JOB 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 ... More
  • Tulsa, OK, USA ● Req #708
    Monday, November 25, 2024
    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 part time during the hours of 8AM -5PM except for lunch and breaks to support behavior ... More
  • Tulsa, OK, USA ● Req #716
    Thursday, November 21, 2024
    JOB 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 ... More
  • Tulsa, OK, USA ● Req #668
    Thursday, November 21, 2024
    JOB 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 ... More
  • Tulsa, OK, USA ● Req #647
    Tuesday, November 12, 2024
    JOB 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 ... More
  • Tulsa, OK, USA ● Req #705
    Tuesday, November 12, 2024
    JOB 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 ... More
  • Tulsa, OK, USA ● Req #641
    Monday, November 4, 2024
    JOB 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 ... More
  • Tulsa, OK, USA ● Req #696
    Monday, November 4, 2024
    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 ... More
  • Tulsa, OK, USA ● Req #695
    Monday, November 4, 2024
    JOB 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 ... More
  • Tulsa, OK, USA ● Req #681
    Monday, November 4, 2024
    JOB 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 ... More
  • Tulsa, OK, USA ● Req #638
    Saturday, October 26, 2024
    JOB 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 ... More
  • Tulsa, OK, USA ● Req #575
    Sunday, October 20, 2024
    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 ... More
  • Tulsa, OK, USA ● Req #576
    Sunday, October 20, 2024
    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 ... More
  • Tulsa, OK, USA ● Req #658
    Sunday, October 20, 2024
    JOB 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 ... More