operations of CommunityCare’s medical claim review program. The Supervisor guides individuals in implementing auditing...
in accordance with federal and state mandates, and credentialing criteria as outlined in the CommunityCare Managed Healthcare Plans...
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...
established by CommunityCare Managed Healthcare Plans of Oklahoma. Processes may include communication with provider...
understanding and sensitivity to the unique needs of the CommunityCare population. This role spends 100% of time on quality program...
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...
JOB SUMMARY: The Member Advocate I serves as a liaison between members and CommunityCare, ensuring a high-quality... need support with navigating their CommunityCare health plan. Assist members in understanding their benefits, claims...
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...
and Responsibilities: Perform other special projects and duties as assigned by the executive staff of CommunityCare Managed Healthcare...
the 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...
JOB SUMMARY: Oversee all aspects of operations of the Pharmacy department including delivery of pharmacy benefits, network, administration, budgeting, reporting, and claims adjudication. Supervise all employees of the Pharmacy department....
JOB SUMMARY: The Provider Performance Specialist plays a key role in strengthening relationships between the health plan and its provider network by offering education, support, and guidance on performance improvement initiatives. This po...
JOB SUMMARY: The Controller, reporting to the CFO, leads all accounting functions and guides financial decisions by establishing, monitoring, and enforcing policies and procedures regarding Accounts Payable, Accounts Receivable, journal e...
The Contract Administrator is responsible for supporting the vendor contracting process from start to finish, including preparation, review, tracking, and maintenance of vendor contracts. This role ensures contract documents are accurate, c...
JOB SUMMARY: Responsible for auditing and monitoring company processes. Meets with stakeholders to review corrective action and obtain resolution. Conducts follow-up audits to ensure corrective actions have addressed the root cause to pre...
JOB 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 mem...
JOB SUMMARY: The Technical Product Owner (TPO) serves as the bridge between business needs and technical implementation, ensuring that product development aligns with strategic objectives and delivers measurable value. The TPO partners cl...
JOB SUMMARY: The Technical Product Owner (TPO) serves as the bridge between business needs and technical implementation, ensuring that product development aligns with strategic objectives and delivers measurable value. The TPO partners cl...
JOB SUMMARY: Responsible for providing daily guidance, instruction and training to inspire the team to perform at their optimum. Will work directly with Customer Service Supervisor to create a team that works efficiently together to maxim...