JOB SUMMARY: The Managed Care Clinical Pharmacist will provide clinical pharmacy support to the CommunityCare...
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...
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...
enrolled in CommunityCare. Take into consideration benefits members are entitled to, access to services, site of care, the...
established by CommunityCare Managed Healthcare Plans of Oklahoma. Processes may include communication with provider...
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...
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...
established by CommunityCare Managed Healthcare Plans of Oklahoma. Processes may include communication with provider...
JOB SUMMARY: The Director of Risk Adjustment is responsible for the strategic design, implementation, and oversight of CCOK’s risk adjustment program for both ACA and Medicare Advantage businesses. This individual will coordinate with var...
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: Ensure integrity of member enrollment data and investigate and resolve complex and exception errors. Duties include identifying potential changes in eligibility, seeking verification of changes and disseminating enrollment in...
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 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 suppor...
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 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: 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 suppor...
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...