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Tulsa, OK, USA ● Req #457Thursday, April 25, 2024JOB SUMMARY: Responsible for conducting clinical behavioral health assessments and/or brief counseling of clients. Make referrals and conducts referral assessments, and follow-up. Provide training and/or workshops to EAP companies. KEY RESPONSIBILITIES: Conducts clinical behavioral health assessments and/or brief counseling of clients and makes referrals to contracted providers for select diagnoses. Monitor and manage affiliate cases to insure appropriate utilization of the EAP. Conducts ...Read more about Employee Assistance Program - EAP Counselor 151-2004More
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JOB SUMMARY: The pharmacy intern will provide support to the CommunityCare Pharmacy Department by participating in Medicare Stars, Medication Adherence, and Medication Therapy Management Programs. This position will also provide clinical support for Pharmacy & Therapeutics, Prior Authorizations, and other clinical reviews and research as needed. Effective communication is an important part of this role. The position will be interacting with members, providers, and other departments within Commu ...Read more about Pharmacy- Seasonal Intern - PharmacyMore
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Tulsa, OK, USA ● Req #331Wednesday, April 24, 2024JOB SUMMARY: The Manager of Data Reporting and Report Development is responsible for architecting advanced data solutions while directing a team of data analysts in providing analytical, operational, cost and quality metrics to both internal and external customers, including regulatory reporting to CMS. This role acts as the Architect of data warehouse data marts and self-service reporting platform solutions. Additionally, this role supervises and manages both a team of health data analysts, ...Read more about Reporting - Manager Data Reporting & Report Development 135-5003More
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Tulsa, OK, USA ● Req #511Monday, April 22, 2024JOB 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 ...Read more about Enrollment Services - Enrollment Processor 160-1028More
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JOB 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 145-1021More
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JOB 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 145-1031More
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JOB SUMMARY: The Complex Claims Specialist is responsible for examining claims that require review prior to being adjudicated. Claims are generally of the largest dollar value and require extreme attention to detail and strong knowledge of claims processing. The examiner will use their resources, knowledge and decision-making acumen to determine the appropriate actions to pay, deny or adjust the claim. The Complex Claims Specialist will generally handle claims involving multiple lines of busi ...Read more about Claims HMO - Complex Claims Specialist 140-1039More
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JOB SUMMARY: Responsible for performing health intake functions, directing members to services needed. KEY RESPONSIBILITIES: •Verifies member eligibility, line of business and network affiliations for members and providers. Determines if the call is clinical and requires transfer to a clinical staff person. Will inform callers, including members, facility personnel, physicians, or other health care professionals of the utilization requirements and procedures. •Makes initial referrals that ...Read more about Behavioral Health - Intake Specialist 150-1003More
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Tulsa, OK, USA ● Req #519Monday, April 22, 2024JOB 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 ...Read more about Customer Service - Supervisor Customer Service 105-4004More
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Tulsa, OK, USA ● Req #485Saturday, April 20, 2024JOB SUMMARY: Primarily responsible for contracting, orientation and ongoing education of physicians, physician office staffs, hospitals and other providers regarding the policies and procedures of CommunityCare Managed HealthCare Plans. Serves as the liaison between the provider community and the health plan. KEY RESPONSIBILITIES: Conducts educational and credentialing PCP and appropriate SCP office site visits according to established standards. Provides ongoing education, develops agendas, ...Read more about Provider Services - Provider Services Representative 115-1005More
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Tulsa, OK, USA ● Req #487Saturday, April 20, 2024JOB 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 an ...Read more about Quality Improvement - Intake Coordinator 195-1012More
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JOB SUMMARY: Responsible for performing health intake functions, directing members to services needed. KEY RESPONSIBILITIES: •Verifies member eligibility, line of business and network affiliations for members and providers. Determines if the call is clinical and requires transfer to a clinical staff person. Will inform callers, including members, facility personnel, physicians, or other health care professionals of the utilization requirements and procedures. •Makes initial referrals that ...Read more about Behavioral Health - Intake Specialist 150-1002More
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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 140-1025More
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Tulsa, OK, USA ● Req #204Saturday, April 20, 2024JOB 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:D ...Read more about Information Technology - Senior Software Engineer 130-2014More
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Tulsa, OK, USA ● Req #444Friday, April 19, 2024JOB SUMMARY: As an Information Technology Intern, you will be assisting in the upgrading of computers from Windows 10 to Windows 11. Working closely with our IT team, the successful candidate will ensure a seamless transition to the latest operating system. This position offers an excellent opportunity for motivated and detail-oriented individuals seeking hands-on experience in IT support and system administration. KEY RESPONSIBILITIES: Assist in the planning and coordination of Windows 11 upg ...Read more about Information Technology- Seasonal Intern- Information TechnologyMore
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Tulsa, OK, USA ● Req #467Friday, April 19, 2024JOB SUMMARY: As an Information Technology Intern, you will be assisting in the upgrading of computers from Windows 10 to Windows 11. Working closely with our IT team, the successful candidate will ensure a seamless transition to the latest operating system. This position offers an excellent opportunity for motivated and detail-oriented individuals seeking hands-on experience in IT support and system administration. KEY RESPONSIBILITIES: Assist in the planning and coordination of Windows 11 upg ...Read more about Information Technology- Seasonal Intern- Information TechnologyMore
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Tulsa, OK, USA ● Req #397Monday, April 15, 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 b ...Read more about Customer Service - Customer Service Representative 105-1054More
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Tulsa, OK, USA ● Req #399Monday, April 15, 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 b ...Read more about Customer Service - Customer Service Representative 105-1053More
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Tulsa, OK, USA ● Req #476Sunday, April 14, 2024JOB 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 i ...Read more about Quality Improvement - Grievance & Appeals Coordinator 195-1022More
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Tulsa, OK, USA ● Req #430Friday, April 12, 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 b ...Read more about Customer Service - Customer Service Representative 105-1016More
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JOB SUMMARY: The Analyst provides analytical support for all departments, including analysis, pricing, capitation, network and provider specific reporting. Analytical support includes creating and executing beginner and intermediate level reports and programs and programming modifications to previously written reports. The Analyst will collaborate with key stakeholders and determine the needed result including any special specifications. The Analyst will work with several databases to pull and ...Read more about Reporting - Health Data Analyst 135-2016More
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Tulsa, OK, USA ● Req #435Wednesday, April 10, 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 b ...Read more about Customer Service - Customer Service Representative 105-1064More
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JOB SUMMARY: Provide enterprise-wide system infrastructure support for effective installation/configuration, operation, and maintenance of systems hardware and software. This individual participates in technical research and development to enable continuing innovation within the infrastructure, as well as ensuring that system hardware, operating systems, software systems, and related procedures adhere to organizational values. This individual will assist project teams with technical issues in the ...Read more about Information Technology - Systems AdministratorMore
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Tulsa, OK, USA ● Req #508Tuesday, April 9, 2024JOB SUMMARY: The IT Infrastructure Leader will be a strategic leader responsible for overseeing the design, implementation, and management of our healthcare plan's technology infrastructure. This role requires a seasoned professional with a strong background in IT infrastructure management, a deep understanding of healthcare operations, and the ability to drive technological advancements that align with our business goals. KEY RESPONSIBILITIES: Develop and execute a comprehensive infrastructu ...Read more about Information Technology - Information Technology Infrastructure Leader 130-2057More
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Tulsa, OK, USA ● Req #479Sunday, April 7, 2024JOB SUMMARY: Supports the PMO in project implementations of various enterprise systems including both vendor-provided solutions and applications developed internally. Works directly with business subject matter experts to clearly define project scope, requirements, process flows and other business needs. Communicates effectively with IT and all levels of the organization. KEY RESPONSIBILITIES: Meet with project stakeholders and end users to review, analyze and create detailed documentation ...Read more about Project Management Operations - PMO Analyst 141-2004More