in accordance with federal and state mandates, and credentialing criteria as outlined in the CommunityCare Managed Healthcare Plans...
operations of CommunityCare’s medical claim review program. The Supervisor guides individuals in implementing auditing...
and requests in accordance with CommunityCare's grievance and appeals procedures. Ensures appropriate file documentation...
JOB SUMMARY: The Compliance and Risk Management Specialist assists in the ongoing success of CommunityCare... risk tolerance levels, and reports on the status of ongoing monitoring of key controls in support of CommunityCare...
operations of CommunityCare’s medical claim review program. The Supervisor guides individuals in implementing auditing...
outreach, exceptional service, and personalized support. The Retention Specialist helps CommunityCare achieve membership growth... events to ensure members are fully informed about CommunityCare benefits and offerings. Contact at-risk members...
understanding and sensitivity to the unique needs of the CommunityCare population. This role spends 100% of time on quality program...
JOB SUMMARY: Responsible for the development, planning and implementation of CommunityCare’s strategic software...
in accordance with federal and state mandates, and credentialing criteria as outlined in the CommunityCare Managed Healthcare Plans...
CommunityCare brand and mission to broker partners (broker agencies, agents and FMOs), contracted providers/health systems..., community leaders and organizations through CommunityCare in person events, health fairs, social and digital marketing...
that wish to be join one of the CommunityCare health plans. Our advocates also provide support via outbound and inbound phone...
JOB SUMMARY: The Medical Review Examiner Nurse is responsible for auditing provider and facility claims. Identifying issues related to and/or participates in various projects aimed at identifying areas of non-compliance and/or potential f...
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 be...
JOB SUMMARY: The UI/UX Developer is responsible for the development of front-end portals using the Angular framework. The UI/UX Developer will be responsible for collaborating with the User Experience team to ensure cohesive branding acro...
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 cu...
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, eligibi...
JOB SUMMARY: The Medical Director provides physician-level clinical review expertise within the health plan’s utilization management, appeals, and clinical governance programs. The Medical Director applies evidence-based clinical judgment...
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, eligibi...
JOB SUMMARY: The Director Actuary will coordinate work with CCOK’s external actuaries, work closely with Marketing, Finance, Underwriting and other departments to find solutions to assist the company in achieving long-term profitable grow...
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, ...