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  • Tulsa, OK, USA ● Req #56
    Monday, August 15, 2022
    JOB SUMMARY: Responsible for monitoring and evaluating patient care practices and the management of resource utilization. KEY RESPONSIBILITIES:Performs Utilization Management activities including collecting and entering data into the database on pre-admission certification, continued review of patient stays, outpatient actions, second surgical opinions, durable medical equipment actions, discharge planning and case management referrals. Works with hospital utilization review personnel, discharge ... More
  • Tulsa, OK, USA ● Req #59
    Tuesday, August 9, 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, and ... More
  • Tulsa, OK, USA ● Req #55
    Friday, August 5, 2022
    JOB SUMMARY: This role serves as the executive leader of the Medicaid line of business and will be responsible for the overall strategic direction, infrastructure development, operations, and management team, administering the plan in line with the organization’s mission and strategic imperatives. This role will be fully accountable for all organizational functions and will report directly to the President & CEO of CommunityCare with guidance from CommunityCare Executives and the Board of Direct ... More
  • Tulsa, OK, USA ● Req #51
    Wednesday, August 3, 2022
    JOB SUMMARY:Responsible for servicing the health plan needs of members and providing information and education on policies, procedures, benefits and services to members. Coordinates the Health Assessment Program to ensure Medicare requirement are met and policy is followed. KEY RESPONSIBILITIES: Responsible for entering HAP assessments into the HAP database, coordinates distribution/mailing of reports, follow up letters and educational materials for all Medicare lines of business. Compile quarte ... More
  • Tulsa, OK, USA ● Req #52
    Wednesday, August 3, 2022
    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 and fr ... More
  • Tulsa, OK, USA ● Req #48
    Thursday, July 28, 2022
    JOB SUMMARY:  Responsible for all written inquiries from members seeking resolution through the grievance and appeals process. KEY RESPONSIBILITIES: Researches member issues and prepares grievance and appeals information for each level of the appeal process. Responsible for adhering to established grievance and appeals timeframes. Assures compliance with Federal, State and Accreditation regulations.Receives and responds to member and/or provider written and oral complaints and requests in accord ... More
  • Tulsa, OK, USA ● Req #45
    Wednesday, July 27, 2022
    JOB SUMMARY:The Sr. Manager, Financial Reporting will create and distribute all internal and external financial reporting documents, as well as manage and coordinate all independent financial statement audits. The Manager must be an effective manager and empathetic leader and demonstrate an ability to engage their team. KEY RESPONSIBILITIES: The Manager must be aware of reporting deadlines and appropriately manage the department activities to meet all reporting deadlines and adhere to regulatory ... More
  • Tulsa, OK, USA ● Req #43
    Wednesday, July 27, 2022
    JOB SUMMARY: Responsible for marketing the company’s commercial products to prospective clients and for assisting in the servicing and retaining existing accounts.   KEY RESPONSIBILITIES: Identifies and sells lines of business directly to potential corporate clients and through an assigned distribution of agents/brokers. Group market includes an emphasis on small and large group market. Must comply with provisions contained within the Sales Compensation Program.  Identi ... More
  • Tulsa, OK, USA ● Req #41
    Wednesday, July 27, 2022
    JOB SUMMARY:This position is responsible for supporting the grievance and appeals activities pertaining to all written inquiries from members and providers requesting resolution through the grievance and appeals process. This includes claims and authorization research. Duties are varied and including typing, filing, photocopying, telephone follow-up, data entry, and preparation of information for presentation at committee meetings. KEY RESPONSIBILITIES: Initiate research for grievance and appeal ... More
  • Tulsa, OK, USA ● Req #39
    Wednesday, July 27, 2022
    JOB SUMMARY: The Manager of the Financial Planning & Analysis Team is responsible for coordinating the assigned workflow for the team members, training, brainstorming and test new assignments, audit existing code, and reports produced by team members. In addition, the manager develops the corporate budget for premium and medical expense, upload data for the Accounting Department for the General and Administrative budget, prepare budget variance explanations and respond to management for work pro ... More
  • Tulsa, OK, USA ● Req #38
    Wednesday, July 27, 2022
    JOB SUMMARY:The Sr. Software Engineer will build out the next generation of our platform. As a Sr. Software Engineer, you are expected to work independently, and within teams, leading the development of software features. Ability to prioritize well, communicate clearly, have a consistent track record of delivery, and excellent software engineering skills. You will be involved with mentoring other team members and helping with identifying process improvements for the team.KEY RESPONSIBILITIES: De ... More
  • Tulsa, OK, USA ● Req #37
    Wednesday, July 27, 2022
    JOB SUMMARY:The Sr. Software Engineer will build out the next generation of our platform. As a Sr. Software Engineer, you are expected to work independently, and within teams, leading the development of software features. Ability to prioritize well, communicate clearly, have a consistent track record of delivery, and excellent software engineering skills. You will be involved with mentoring other team members and helping with identifying process improvements for the team.KEY RESPONSIBILITIES:Dev ... More
  • Tulsa, OK, USA ● Req #36
    Wednesday, July 27, 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 facilitation ... More
  • Tulsa, OK, USA ● Req #34
    Wednesday, July 27, 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 guide ... More
  • Tulsa, OK, USA ● Req #33
    Wednesday, July 27, 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 facilitation ... More
  • Tulsa, OK, USA ● Req #32
    Wednesday, July 27, 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 facilitation ... More
  • Tulsa, OK, USA ● Req #31
    Wednesday, July 27, 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 #30
    Wednesday, July 27, 2022
    JOB SUMMARY: Responsible for auditing and testing company processes and controls for compliance with regulatory requirements and company policies. Meet with process owners to discuss instances of non-compliance and request corrective action plans, where necessary. Prepare audit reports and present to the Internal Audit Committee. Track and monitor corrective action plans through implementation. Validate identified issues to ensure that corrective actions have addressed the root cause and are pre ... More
  • Tulsa, OK, USA ● Req #26
    Wednesday, July 27, 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 #25
    Wednesday, July 27, 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 #24
    Wednesday, July 27, 2022
    JOB SUMMARY:  This position is responsible for maintaining the entry and maintenance of the customer database. Maintains customer files and data according to regulations. KEY RESPONSIBILITIES: Generates customer correspondence and distributes information. Creates and maintains customer eligibility in the database. Reviews information to determine requirements. Reviews and processes enrollment information to ensure compliance with all regulations. Accountable for meeting quality and production be ... More
  • Tulsa, OK, USA ● Req #28
    Tuesday, July 26, 2022
    JOB SUMMARY:The Customer Service Supervisor will build a strong team of Customer Service Representatives and shape staff behaviors to accomplish desired results to meet the expectations and needs of our members, providers and internal customers. You will be responsible for providing ongoing coaching to inspire our Customer Service Representatives to deliver exceptional customer service as well as coaching to develop CSRs in their current role or to take on additional responsibilities.You will pl ... More