Job Search
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JOB SUMMARY: The Quality Improvement Stars Specialist is an integral part of the team, focusing on enhancing the performance of quality programs. This role requires a proactive individual who is adept at working collaboratively with provider groups and multidisciplinary teams with minimal oversight to ensure adherence to deadlines and compliance with regulatory requirements. The specialist will play a pivotal role in the analysis, development, and implementation of strategies aimed at improvin ...Read more about Quality Improvement - QI Stars Specialist_195-2016More
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Tulsa, OK, USA ● Req #772Wednesday, March 19, 2025JOB SUMMARY: This non-clinical position supports the department by performing a broad range of clerical duties. KEY RESPONSIBILITIES: Prepares correspondence to members, providers, and facilities. Provides follow up with providers and members as needed. Reviews service requests for completeness of information. Enters information into the database, compiles data and runs reports. Receives telephone calls, answers non-clinical questions and takes information, or refers callers to appropriate ...Read more about Medical Management - Intake Coordinator 145-1029More
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Tulsa, OK, USA ● Req #775Tuesday, March 18, 2025JOB 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 ...Read more about Medical Management - Concurrent Review Nurse- RN 145-2006More
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Tulsa, OK, USA ● Req #776Tuesday, March 18, 2025JOB 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 ...Read more about Medical Management - Concurrent Review Nurse- RN 145-2018More
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Tulsa, OK, USA ● Req #762Tuesday, March 18, 2025The 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 Medical Review (MRE) staff including analysis, problem solving, and ...Read more about Medical Management - Supervisor Medical Review 145-4005More
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Tulsa, OK, USA ● Req #761Tuesday, March 18, 2025JOB SUMMARY: Focus on the development and support of new and existing Database Management Systems (DBMS). Responsible for the design, development and implementation of new applications as well as maintaining and updating existing programs. KEY RESPONSIBILITIES: Perform Oracle DBA Functions Design and analysis of critical Database Management Systems (DBMS) related to the AMISYS systems and surround code programs. Design, code, test, maintain and document structured desktop and web programs u ...Read more about Information Technology - Senior Programmer Analyst 130-2009More
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Tulsa, OK, USA ● Req #765Tuesday, March 18, 2025JOB SUMMARY: Responsible for the negotiation, execution and implementation of all HMO, PPO and Government Programs, provider contracts including value based and complex. Responsible for the supervision (planning, execution, implementing and monitoring) of all aspects of the provider contracting staff. Responsible for contract related processes and procedures under the direction of the Director, Provider Relations. Responsible for ensuring provider contracting is performed in compliance with all ...Read more about Provider Services - Supervisor Provider Contracting 115-4000More
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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 ...Read more about Behavioral Health - Intake Specialist 150-1001More
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Tulsa, OK, USA ● Req #766Tuesday, March 18, 2025JOB 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)More
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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 ...Read more about Marketing - Account Manager 110-2004More
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Tulsa, OK, USA ● Req #641Saturday, March 1, 2025JOB 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 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