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  • Tulsa, OK, USA ● Req #100
    Monday, September 26, 2022
    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 be ... More
  • Tulsa, OK, USA ● Req #101
    Monday, September 26, 2022
    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 be ... More
  • Tulsa, OK, USA ● Req #99
    Monday, September 26, 2022
    JOB SUMMARY:  Responsible for clinical review of services requiring medical authorization and documentation of decisions and clinical information. This role practices independent judgement using clinical knowledge prioritizing cases based upon medical necessity and regulatory guidelines. In addition, uses discretion with everyday confidentiality preserving patient cases.  KEY RESPONSIBILITIES: Reviews requests for services (inpatient, ancillary, and outpatient). Makes decisions according to guid ... More
  • Tulsa, OK, USA ● Req #98
    Monday, September 26, 2022
    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 in determ ... More
  • Tulsa, OK, USA ● Req #96
    Monday, September 26, 2022
    JOB SUMMARY:  Responsibilities include performing credentialing activities consistently for each applicant in accordance with federal and state mandates, and credentialing criteria as outlined in the CommunityCare Managed Healthcare Plans of Oklahoma Policy and Procedure Manual.  KEY RESPONSIBILITIES: Responsible for initial assessment of applications and other data for accuracy and completeness and contacting applicants or other outside resources to resolve questions or to obtain missing inform ... More
  • Tulsa, OK, USA ● Req #83
    Wednesday, September 14, 2022
    JOB SUMMARY: The Manager, Health Programs will oversee and drive the health plan to achieve optimal star ratings for Medicare related product lines. The Manager will assist in developing strategy and translate strategy and goals into execution within a matrixed organizational environment. This roles overall percentage of responsibilities pertaining to quality activities is 100%. KEY RESPONSIBILITIES:Manage and work with Stars program management team, and health plan and provider leadership to de ... More
  • Tulsa, OK, USA ● Req #84
    Wednesday, September 14, 2022
     JOB SUMMARY: This position will serve as the specialist for updating and correcting member addresses in CommunityCare databases. Updating procedures will include researching current addresses, formatting addresses per CommunityCare standards, emailing and calling members to verify current addresses, and using NCOA files and other address change notifications to update systems. KEY RESPONSIBILITES:Updating addresses in system databasesEmail members about address clarificationCalling members to u ... More
  • Tulsa, OK, USA ● Req #81
    Wednesday, September 14, 2022
    JOB SUMMARY:  Responsible for working with members, providers, and other multidisciplinary team members to facilitate, collaborate and coordinate healthcare for members identified with complex healthcare needs. Work with members throughout the continuum of care to enhance the members healthcare experience and assist with the provision of cost-effective healthcare options.  KEY RESPONSIBILITIES: Complete clinical assessments of members requiring case management oversite to assist with facilitatio ... More
  • Tulsa, OK, USA ● Req #78
    Wednesday, September 14, 2022
    JOB SUMMARY:  Provide enterprise-wide system infrastructure support for complex system and interconnected technologies that require day-to-day support and administration to maintain optimum performance and utilization. This individual will also mentor and provide guidance to the Systems Engineer staff.  KEY RESPONSIBILITIES:  Maintain infrastructure environment. Install, configure, and maintain server equipment, disk arrays, tape libraries and virtual tape libraries. Perform routine backup and r ... More
  • Tulsa, OK, USA ● Req #93
    Thursday, September 8, 2022
    JOB SUMMARY:  Responsible for identifying specific patient populations, assessing opportunities to manage patient care, developing treatment plans to meet goals or facilitate discharge and coordinating that care. KEY RESPONSIBILITIES: Responsible for clinical review of inpatient and post-acute care settings. Assist with review of root cause analysis for members identified as high dollar, complex needs, or at risk for re admissions. Assess patient population for appropriateness of referral, level ... More
  • Tulsa, OK, USA ● Req #71
    Thursday, September 8, 2022
    JOB SUMMARY:  This position supports the department by performing a broad range of clerical duties. KEY RESPONSIBILITIES: Prepares correspondence to members and provider facilities. Follow up with providers and members as needed. Enters information into the database, compiles data and runs reports. Receives telephone calls, answers question and takes information, or refers callers to appropriate parties. Investigates and researches complaints from members, physician offices, ancillary vendors, a ... More
  • Tulsa, OK, USA ● Req #94
    Thursday, September 8, 2022
    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 in determ ... More
  • Tulsa, OK, USA ● Req #86
    Thursday, September 1, 2022
    JOB SUMMARY:The Senior Manager of Behavioral Health is responsible for managing the Behavioral Health services providing strategic leadership in the design and implementation of a cogent behavioral health strategy. Ensures strategic alignment with organizational goals meeting the needs of members, providers and accounts. The position includes the oversight both in-house and delegated clinical and health plan business operations including but not limited to; proper administration of behavioral he ... More
  • Tulsa, OK, USA ● Req #88
    Thursday, September 1, 2022
    JOB SUMMARY:Responsible for management (planning, execution, implementing and monitoring) of all aspects of the company’s HMO and PPO provider network professional staff including provider relations and contracting under the direction of the Director, Provider Relations. Participates in development of network strategies and provider compensation models. Responsible for overseeing the negotiation, execution and implementation of all provider contracts, including execution of single case letters o ... More
  • Tulsa, OK, USA ● Req #89
    Thursday, September 1, 2022
    JOB SUMMARY:The Director (Controller) of Medicaid Accounting will be responsible for all internal and external financial reporting for CommunityCare.   KEY RESPONSIBILITIES: All financial reporting for the Medicaid LOB including the management of the accounting ledgers.Compliance with all contractual and regulatory financial reporting requirements.Meeting internal and external deadlines for financial reporting.Manage and develop supporting staff.QUALIFICATIONS: Expert level understanding o ... More
  • Tulsa, OK, USA ● Req #90
    Thursday, September 1, 2022
    JOB SUMMARY:The Senior Manager of Health Equity is responsible for managing the Health Equity services for the CommunityCare community and stakeholder engagement experience, while applying application of science-based quality improvement methods to reduce health disparities. Coordinates activities with Community Benefit Organizations (CBOs), tribal organizations, governmental departments and other external parties. Serves as a resource for Health Equity tools. Oversees the administration of vari ... More
  • Tulsa, OK, USA ● Req #91
    Thursday, September 1, 2022
    JOB SUMMARY:Manage Medicaid financial analytics.KEY RESPONSIBILITIES: Calculation of claims liability.Reconciliation of provider contracts.Reconciliation and provider incentives.Analysis of capitation rates (OHCA capitation revenue).Identification of cost and quality improvement opportunities.Management and training of support staff.Reporting and presentation of financial reconciliations and analysis.Forecast medical cost and utilization trends.Analysis and inclusion of risk adjustment in cont ... More
  • Tulsa, OK, USA ● Req #79
    Wednesday, August 31, 2022
    JOB SUMMARY:  Responsible for leading and directing projects, including research and data analysis in developing and implementing projects which further the strategic objectives of the organization. Manage the project lifecycle by overseeing, monitoring and evaluating day-to-day progress toward project objectives, deliverables and on-time project completion. KEY RESPONSIBILITIES: Manage projects with effective planning, tracking and monitoring to meet deadlines and requirements within the compan ... More
  • Tulsa, OK, USA ● Req #75
    Wednesday, August 31, 2022
    JOB SUMMARY:  The Medicaid Medical Director will serve as an organizationally focused leader and have primary responsibility for assisting the Senior VP & Chief Medical Officer in designing, building, and operating the Medical Management functions for Medicaid. This clinician will additionally have responsibility for Medicaid care management and utilization management operations in conjunction with other leaders. This key role sets the tone and provides leadership to a large team of nurses and s ... More
  • Tulsa, OK, USA ● Req #76
    Wednesday, August 31, 2022
    JOB SUMMARY:  The Data Engineer will be responsible for expanding, optimizing and monitoring our data and data pipeline architecture, as well as optimizing data flow and collection across organizational teams. The Data Engineer will support our software engineers, database architects and data analysts on data initiatives and will ensure optimal data delivery architecture is consistent throughout ongoing projects. KEY RESPONSIBILITIES: Create and maintain optimal data pipeline architecture to sup ... More
  • Tulsa, OK, USA ● Req #65
    Wednesday, August 31, 2022
    JOB SUMMARY:  Responsible for leading and directing IT related projects from development through completion and ensuring successful output; outline the project goals and objectives, while acting as a liaison between the program staff, management and business groups. Manage status reporting, stability of assigned project-oriented work efforts, customer expectations for contracted time, cost, and requirements definitions. Provides a single point of contact for project assignments. Assembles projec ... More
  • Tulsa, OK, USA ● Req #67
    Wednesday, August 31, 2022
    JOB SUMMARY:  Supports the development, integration and delivery of various enterprise systems. This includes both vendor-provided solutions as well as in-house developed applications, helping to identify and communicate business requirements to the IT department. This involves working directly with business subject matter experts to clearly define process flows, API definitions and other business needs and be able to effectively communicate those to IT. Will also interface with internal PMO gro ... More
  • Tulsa, OK, USA ● Req #80
    Tuesday, August 30, 2022
    JOB SUMMARY:The Recruiting Specialist will support our Recruiting team with the objective of increasing the candidate pipeline by sourcing candidates, assessing qualifications, and positioning them appropriately for job opportunities within CommunityCare. KEY RESPONSIBILITIES: Supports the Sr. Talent Advisor with new hire onboarding including coordinating background and drug screening. Assisting with candidate email and phone correspondence, as well as participating in various projects such as j ... More
  • Tulsa, OK, USA ● Req #66
    Friday, August 26, 2022
    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 independently an ... More
  • Tulsa, OK, USA ● Req #68
    Friday, August 26, 2022
    JOB SUMMARY:Responsible for selling Medicare products and Individual Health Plan products via telemarketing calls and person-to-person meetings, including seminars. KEY RESPONSIBILITIES: Discuss products and benefits with eligible beneficiaries on a person to person basis in various settings. Makes outbound calls, as allowed, to prospects to answer questions and to schedule further sales follow up calls.Receives inbound calls from prospective enrollees, answer questions about company products, b ... More