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<h3> Position Summary </h3> Industry-leading clients. An award-winning culture. Top notch connections. Big opportunities. From learning to leadership, this is your chance to take your career to the next level. Deloitte can show you what it takes to explore an entire universe of ideas, possibilities, and opportunities—and help make an impact that matters with SAP solutions. Recruiting for this role ends on May 31, 2025. Work you’ll do At Deloitte, you’ll work with the best in the business to solve their toughest problems. <ul> <li>Responsible for delivering complex projects in a fast-paced, team environment.</li> <li>Promote and take part in forums for sharing expertise and strengthening Deloitte’s collective knowledge.</li> <li>Collaborate on innovative solutions to bolster the future of the practice.</li> <li>Develop your knowledge of and gain project experience in SAP’s newest and future solutions.</li> </ul> The team Deloitte’s SAP practice helps clients move from legacy systems to enterprise-wide solutions by efficiently designing and implementing SAP solutions. Each SAP implementation focuses on achieving results that support businesses strategies through process improvement, technology, and innovation. Our work is varied and challenging, involving clients considering first time implementations as well as those experienced businesses looking to enhance their business applications. We work with clients who want to improve their ability to react in digital world and enable scalability, remove performance barriers, enable innovation, and modernize core systems and reimagine their business with SAP digital solutions. Our professionals have hands-on access and exposure to the latest technologies and committed thought pioneers. Qualifications Required: <ul> <li>At least 5 years’ relevant SAP consulting experience in a professional services environment, with a large or boutique consulting firm, or serving as an internal consultant within industry</li> <li>At least 2 years of experience working in the Aerospace &amp; Defense (A&amp;D) industry or with A&amp;D clients</li> <li>SAP FICO experience</li> <li>SAP Projects Systems experience</li> <li>Deep knowledge and implementation experience with SAP GPD (Grouping, Pegging and Distribution) or PMMO (Project, Manufacturing, Management and Optimization) modules</li> <li>Hands-on functional configuration and design experience with SAP GPD or SAP PMMO, and SAP Project Systems</li> <li>S4 HANA implementation experience </li> <li>Participation in at least 2 end-to-end SAP Finance/GPD/PMMO implementations, and in a workstream sub-lead or lead role on at least 1 implementation</li> <li>Strong oral and written communication skills, including presentation skills; professional competence in the Microsoft Office suite (Word, Excel, PowerPoint, Access)</li> <li>Ability to travel up to 50% based on work you do and the client and industries/sectors you serve </li> <li>Bachelor's degree or equivalent </li> </ul> Desired: <ul> <li>Prior “Big 4” consulting experience</li> <li>Experience delivering projects using SAP ASAP and Agile methodologies </li> <li>Signavio experience </li> <li>Greenfield implementation experience </li> <li>Master’s degree </li> </ul> <a href="https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-assistance-for-disabled-applicants.html" target="_blank">Information for applicants with a need for accommodation:</a> Wages + Salary The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $113,325 to $188,875. You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance. #SAP23 #EPCORE Recruiting tips From developing a stand out resume to putting your best foot forward in the interview, we want you to feel prepared and confident as you explore opportunities at Deloitte. <a href="https://www2.deloitte.com/us/en/pages/careers/topics/recruiting-tips.html" target="_blank">Check out recruiting tips from Deloitte recruiters.</a> Benefits At Deloitte, we know that great people make a great organization. We value our people and offer employees a broad range of benefits. <a href="https://www2.deloitte.com/us/en/pages/careers/articles/life-at-deloitte-benefits-and-rewards.html" target="_blank">Learn more about what working at Deloitte can mean for you.</a> Our people and culture Our diverse, equitable, and inclusive culture empowers our people to be who they are, contribute their unique perspectives, and make a difference individually and collectively. It enables us to leverage different ideas and perspectives, and bring more creativity and innovation to help solve our client most complex challenges. This makes Deloitte one of the most rewarding places to work. <a href="https://www2.deloitte.com/us/en/pages/about-deloitte/articles/deloitte-inclusion.html" target="_blank">Learn more about our inclusive culture.</a> Our purpose Deloitte’s purpose is to make an impact that matters for our clients, our people, and in our communities. We are creating trust and confidence in a more equitable society. At Deloitte, purpose is synonymous with how we work every day. It defines who we are. We are focusing our collective efforts to advance sustainability, equity, and trust that come to life through our core commitments. <a href="https://www2.deloitte.com/us/en/pages/about-deloitte/articles/purpose-at-deloitte-us.html" target="_blank">Learn more about Deloitte's purpose, commitments, and impact.</a> Professional development From entry-level employees to senior leaders, we believe there’s always room to learn. We offer opportunities to build new skills, take on leadership opportunities and connect and grow through mentorship. From on-the-job learning experiences to formal development programs, our professionals have a variety of opportunities to continue to grow throughout their career.

Deloitte

SAP GPD/PMMO Senior Consultant (A&D Industry)

<h2>Job Details</h2> Job Location Tulsa, OK <h2>Description</h2> Salary: $70,000-$80,000 (dependent on experience) ACES is driven to elevate the standards in the treatment of autism. Our team of Applied Behavior Analysis (ABA) clinicians is deeply committed to helping children with autism and related disorders reach their fullest potential through home and clinic-based services. ACES is the only autism provider who is nationally recognized for quality care as part of <a href="https://www.acesaba.com/news/institute-of-quality-for-autism/" target="_blank">Aetna/CVS’s Institute of Quality</a>. We are also an award-winning workplace where you can grow your career, collaborate with a supportive team, and make a lasting impact on the lives of people in your community. What You'll Do: <ul> <li>Design, develop and implement a wide range of ABA programs for children with autism and other developmental disabilities </li> <li>Collaborate with families and other clinicians to tailor ABA programs to specific client needs </li> <li>Supervise and mentor Behavior Technicians delivering direct services </li> <li>Evaluate and update client progress reports via industry-leading data collection software </li> <li>Collaborate with a cross-functional team dedicated to ACES’ mission </li> </ul> What You'll Love: <ul> <li>Competitive total compensation with monthly performance incentive </li> <li>Career and compensation growth opportunity from Supervisor to Area Manager then Area Director and beyond </li> <li>12 free, in-house CEUs (one a month) </li> <li>Company-paid life insurance with buy-up option </li> <li>Access to Identity and Legal shield services </li> <li>Company-provided laptop </li> <li>Flexible, uplifting and supportive work environment, including company-sponsored social events </li> <li>Opportunities for relocation assistance, student loan reimbursement and sign-on bonus for qualified applicants</li> </ul> <h2>Qualifications</h2> What We're Looking For: <ul> <li>Board Certified Assistant Behavior Analyst (BCaBA) in good standing</li> <li>Proven experience developing and implementing client programs (preferably in the ABA industry) </li> <li>Enthusiastic leaders who enjoy training, managing and supporting entry-level direct care staff </li> <li>Must pass a criminal background check, TB test, and have or receive immunities to MMR/VZV </li> </ul> Additional Information ACES is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender, gender identity, sexual orientation, marital status, national origin, disability, age or covered veteran status. To find out more about how ACES uses employee data for business purposes, see our<a href="https://acesaba.com/employees-privacy-policy/" target="_blank">Employee Privacy Policy.</a> If you are having any issues with submitting your application, please reach out to us directly at <a href="#">careers@acesaba.com</a> If you require alternative methods of application or screening, you must approach the employer directly to request this as Indeed is not responsible for the employer's application process.

Comprehensive Educational Services

Clinical Supervisor BCaBA

<h3> Position Summary </h3> Industry-leading clients. An award-winning culture. Top notch connections. Big opportunities. From learning to leadership, this is your chance to take your career to the next level. Deloitte can show you what it takes to explore an entire universe of ideas, possibilities, and opportunities—and help make an impact that matters with SAP solutions. Recruiting for this role ends on May 31, 2025 Work you’ll do At Deloitte, you’ll work with the best in the business to solve their toughest problems. As a Senior Consultant, you will contribute to the growth and success of Deloitte Consulting LLP and the SAP Offering in a variety of ways, including: <ul> <li>Support client work on data planning, strategy, and execution </li> <li>Assist with managing the development and testing activities for the data migration process for S/4 HANA implementations</li> <li>Be a part of the data team through the scope, extraction, mapping, and loading of both the master data sets &amp; transactional data sets from multiple sources into SAP system through the project phases and go-live</li> <li>Support SAP Technology pursuits and Practice Development initiatives</li> <li>Be involved in the development external eminence across the sub-capabilities in SAP</li> </ul> The team Deloitte’s SAP practice helps clients move from legacy systems to enterprise-wide solutions by efficiently designing and implementing SAP solutions. Each SAP implementation focuses on achieving results that support businesses strategies through process improvement, technology, and innovation. Our work is varied and challenging, involving clients considering first time implementations as well as those experienced businesses looking to enhance their business applications. We work with clients who want to improve their ability to react in digital world and enable scalability, remove performance barriers, enable innovation, and modernize core systems and reimagine their business with SAP digital solutions. Our professionals have hands-on access and exposure to the latest technologies and committed thought pioneers. Qualifications Required: <ul> <li>5 years’ relevant SAP consulting experience </li> <li>2+ full life cycle SAP implementations of data migration projects</li> <li>Experience with Material, Customer, and Vendor Master Data conversions</li> <li>Strong understanding of Data Migration Methodology (ETL) including profiling, cleansing, and validation activities</li> <li>Experience with using various data migration tools and solutions that apply to SAP data migration implementations (Syniti, BODS, MDG, etc.)</li> <li>Knowledge of ABAP Development Programming Skills</li> <li>S4 HANA implementation experience</li> <li>Hands-on functional configuration and design experience with the module/skill for the role</li> <li>Ability to travel up to 50% based on work you do and the client and industries/sectors you serve</li> <li>Bachelor’s degree or equivalent</li> </ul> Desired: <ul> <li> Knowledge of MDM solutions to create and maintain master data</li> <li> Self-developer on SAP S/4 and other SAP models that would require converted data in a transformation program</li> <li> Prior "Big 4" consulting experience</li> <li> Greenfield implementation experience</li> <li> Experience delivering projects using SAP ASAP &amp; Agile methodologies</li> <li> Signavio experience</li> <li> Master’s degree</li> </ul> <a href="https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-assistance-for-disabled-applicants.html" target="_blank">Information for applicants with a need for accommodation</a> Wages + Salary The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $113,325 to $188,875. You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance #SAP23 #EPCORE Recruiting tips From developing a stand out resume to putting your best foot forward in the interview, we want you to feel prepared and confident as you explore opportunities at Deloitte. <a href="https://www2.deloitte.com/us/en/pages/careers/topics/recruiting-tips.html" target="_blank">Check out recruiting tips from Deloitte recruiters.</a> Benefits At Deloitte, we know that great people make a great organization. We value our people and offer employees a broad range of benefits. <a href="https://www2.deloitte.com/us/en/pages/careers/articles/life-at-deloitte-benefits-and-rewards.html" target="_blank">Learn more about what working at Deloitte can mean for you.</a> Our people and culture Our diverse, equitable, and inclusive culture empowers our people to be who they are, contribute their unique perspectives, and make a difference individually and collectively. It enables us to leverage different ideas and perspectives, and bring more creativity and innovation to help solve our client most complex challenges. This makes Deloitte one of the most rewarding places to work. <a href="https://www2.deloitte.com/us/en/pages/about-deloitte/articles/deloitte-inclusion.html" target="_blank">Learn more about our inclusive culture.</a> Our purpose Deloitte’s purpose is to make an impact that matters for our clients, our people, and in our communities. We are creating trust and confidence in a more equitable society. At Deloitte, purpose is synonymous with how we work every day. It defines who we are. We are focusing our collective efforts to advance sustainability, equity, and trust that come to life through our core commitments. <a href="https://www2.deloitte.com/us/en/pages/about-deloitte/articles/purpose-at-deloitte-us.html" target="_blank">Learn more about Deloitte's purpose, commitments, and impact.</a> Professional development From entry-level employees to senior leaders, we believe there’s always room to learn. We offer opportunities to build new skills, take on leadership opportunities and connect and grow through mentorship. From on-the-job learning experiences to formal development programs, our professionals have a variety of opportunities to continue to grow throughout their career.

SAP Data Migration Senior Consultant

<h1>Claims HMO - Claims Examiner 140-1008</h1> Tulsa, OK, USA Req #634 Monday, January 13, 2025 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: <ul> <li>Examining and adjudicating claims that have pended for review utilizing resources, tools, knowledge and decision-making in determining appropriate actions.</li> <li>Identify claims requiring additional resources and route to the team lead, supervisor or other departments as needed.</li> <li>Enter claims information using the processing software to compute payments, allowable amounts, limitations, exclusions and denials.</li> <li>Identify and communicate trends or problems identified during adjudication process.</li> <li>Contribute to the creation of a pleasant working environment with peers and other departments.</li> <li>Assist in investigating and solving claims that require additional research.</li> <li>Consistently learn and adapt to changes related to claims processing, benefits, limits and regulations.</li> <li>Perform other duties as assigned.</li> </ul> QUALIFICATIONS: <ul> <li>Self-motivated and able to work with minimal direction.</li> <li>Ability to read and understand claims processing manuals, medical terminology, CPT codes, and perform basic processing procedures.</li> <li>Ability to read and understand health benefit booklets.</li> <li>Demonstrated learning agility.</li> <li>Successful completion of Health Care Sanctions background check.</li> <li>Knowledge in the contracted managed care plan terms and rates.</li> <li>General understanding of unbundling methods, COB, and other over-billing methodologies.</li> <li>Must have high attention to detail.</li> <li>Proficient in Microsoft applications.</li> <li>Ability to perform basic mathematical calculations.</li> <li>Possess strong oral and written communication skills.</li> </ul> EDUCATION/EXPERIENCE: <ul> <li>High School Diploma or Equivalent required.</li> <li>Two years related work experience in claims processing, claims data entry or medical billing OR medical related education to meet minimum two years required.</li> </ul> CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin <h2 id="otherDetailsHeader">Other details</h2> <ul> <li> Job Family Commercial </li> <li> Pay Type Hourly </li> </ul> <a href="#"> Apply Now </a>

CommunityCare

Claims HMO - Claims Examiner 140-1008

Classy, an affiliate of GoFundMe, is a Public Benefit Corporation and giving platform that enables nonprofits to connect supporters with the causes they care about. Classy's platform provides powerful and intuitive fundraising tools to convert and retain donors. Since 2011, Classy has helped nonprofits mobilize and empower the world for good by helping them raise over $7 billion. Classy also hosts the Collaborative conference and the Classy Awards to spotlight the innovative work nonprofits are implementing around the globe. For more information, visit <a href="http://www.classy.org/" target="_blank">www.classy.org</a>. We’re building something new! Classy'sCustomer Care Team is looking for an innovative and experienced Manager to lead our Enterprise Care operations comprising our incredible Technical Account Managers and newly established Enterprise Support team. You’ll play a critical role in helping the world's largest nonprofits across the country make the world a better place through product education, technical assistance and results focused encouragement. You’ll also serve as the voice of Classy’s brand, building rewarding relationships that keep customers engaged and enthusiastic. The ideal candidate has experience working with Enterprise Organizations and leads with empathy, ability to work in a fast paced environment, and a knack for sharing knowledge. We want to talk to you if you love being part of a teamthat genuinely Cares about our nonprofit customers and the missions they serve. We aren’t your normal Customer Care team. We go above and beyond to advocate on behalf of our nonprofits across Classy to make their product and support experience world class. The Job… <ul> <li>Lead our (TAMs) Technical Account Management (4) and Enterprise Support teams (5-7) to deliver an exceptional enterprise care experience.</li> <li>Prioritizes proactive care through enabling our TAMs to drive customer success and platform performance. </li> <li>Oversee all channels of customer support, including chat, email, video and phone, ensuring timely and effective resolution of customer inquiries and issues.</li> <li>Ensure the team is fully optimized by managing day to day tasks (timekeeping, PTO) utilizing Care KPIs to drive maximum impact and generate value.</li> <li>A people first leader - drive employee career development within Care and beyond, setting your people up for long term success and growth.</li> <li>Work alongside our Quality Associate Manager, Scaled Care Manager and Technical Support Management to provide on-going coaching addressing all channels as well as delivering new process and procedures when needed for both internal and offshore teams.</li> <li>Serve as an escalation point for your direct reports, our Enterprise Customers and internal Classy organization, acting as a product and process expert for Enterprise care.</li> <li>Work with the Director, Care and wider CX organization to optimize the customer journey across all touchpoints through effective, customer focused collaboration and taking action cross functionally to drive CX enhancements.</li> <li>Proactively seek solutions to improve operational efficiency and quality by working with product, operation and policy teams.</li> </ul> You… <ul> <li>3+ years experience Managing a customer facing team with an Enterprise Customer Base.</li> <li> Exceptional oral and written communication. Communicates respectfully, clearly, and with decisiveness, especially under challenging circumstances.</li> <li> World-class change management skills. Thrive in a world where you’ll balance team needs, changing priorities, and new ideas</li> <li> Strong emotional intelligence. You can read your team, empathize with their unique challenges and adapt to foster world-class experiences. </li> <li> Extremely process-oriented. You’re resourceful when a process or an answer doesn’t exist and seek to evolve the way Classy Care operates.</li> <li> Willing to take risks. You thrive in highly-matrixed environment that often involves taking risks that may succeed or may fail, but know that learning from those failures is what will push the team forward. </li> <li> Mission-driven mindset. You want a job with purpose and serve a team whose mission it is to drive the success of our customers. </li> <li> Lead By Example. Your poise, attitude, and tenacity are front and center and the team will follow your lead.</li> <li> Dream BIG and execute smart. Your enthusiasm for challenging the status quo through innovation is contagious. </li> <li> Proactively uncover opportunities. You can identify trends, investigate anomalies and present recommendations to the rest of the leadership team and your cross-functional partners. </li> </ul> Preferred… <ul> <li> Experience building new customer journeys. If you already have a deep understanding of the unique challenges Customer Care teams in SaaS face, we want to hear from you. </li> </ul> Why you’ll love it here... <ul> <li> Make an Impact: Be part of a mission-driven organization making a positive difference in millions of lives every year.</li> <li> Innovative Environment: Work with a diverse, passionate, and talented team in a fast-paced, forward-thinking atmosphere.</li> <li> Collaborative Team: Join a fun and collaborative team that works hard and celebrates success together.</li> <li> Competitive Benefits: Enjoy competitive pay and comprehensive healthcare benefits.</li> <li> Holistic Support: Enjoy financial assistance for things like hybrid work, family planning, and commuting, along with generous parental leave, flexible time-off policies, and mental health and wellness resources to support your overall well-being.</li> <li> Growth Opportunities: Participate in learning, development, and recognition programs to help you thrive and grow.</li> <li> Commitment to DEI: Contribute to diversity, equity, and inclusion through ongoing initiatives and employee resource groups.</li> <li> Community Engagement: Make a difference through our volunteering and Gives Back programs.</li> </ul> We live by our core values: impatient to be great, find a way, earn trust every day, fueled by purpose. Be a part of something bigger with us! GoFundMe is proud to be an equal opportunity employer that actively pursues candidates of diverse backgrounds and experiences. We are committed to providing diversity, equity, and inclusion training to all employees, and we do not discriminate on the basis of race, color, religion, ethnicity, nationality or national origin, sex, sexual orientation, gender, gender identity or expression, pregnancy status, marital status, age, medical condition, mental or physical disability, or military or veteran status. The total annual salary for this full-time position is $96,000 - $144,000 + equity + benefits. As this is a remote position, the salary range was determined by role, level, and possible location across the US. Individual pay is determined by work location and additional factors including job-related skills, experience, and relevant education or training. Your recruiter can share more about the specific salary range based on your location during the hiring process. If you require a reasonable accommodation to complete a job application or a job interview or to otherwise participate in the hiring process, please contact us at <a href="#">accommodationrequests@gofundme.com</a> Dedication to Diversity GoFundMe and Classy are committed to leveraging Diversity, Equity, Inclusion, and Belonging to cultivate a culture that embraces and supports the unique identities, experiences, and perspectives of our people and customers. Our diversity recruiting priority is recognized under our first DEIB Driver: Opportunity Foster Diversity - we identify, recruit, and invest in top talent- ensure our people reflect the unique identities, experiences, and perspectives of the communities we serve and are all given the chance to grow. Global Data Privacy Notice for Job Candidates and Applicants: Depending on your location, the General Data Protection Regulation (GDPR) or certain US privacy laws may regulate the way we manage the data of job applicants. Our full notice outlining how data will be processed as part of the application procedure for applicable locations is available <a href="https://www.gofundme.com/c/personal-privacy-notice-for-classy-and-gofundme" target="_blank">here</a>. By submitting your application, you are agreeing to our use and processing of your data as required. Learn more about GoFundMe: We’re proud to partner with <a href="https://www.gofundme.org/" target="_blank">GoFundMe.org</a>, an independent public charity, to extend the reach and impact of our generous community, while helping drive critical social change. You can learn more about GoFundMe.org’s activities and impact in their <a href="https://www.gofundme.org/wp-content/uploads/2024/08/GoFundMe.org-FY24-Annual-Report.pdf" target="_blank">FY ‘24 annual report</a>. Our<a href="https://www.gofundme.com/c/gofundme-2024-year-in-help" target="_blank"> annual “Year in Help” report </a>reflects our community’s impact in advancing our mission of helping people help each other. For recent company news and announcements, visit our <a href="https://www.gofundme.com/c/newsroom" target="_blank">Newsroom</a>.

Classy

Manager, Enterprise Care

<h1>Medical Management - Medical Director 145-7004</h1> Tulsa, OK, USA Req #718 Tuesday, December 31, 2024 JOB SUMMARY: The Medical Director will exhibit strong expertise in utilization management and health plan leadership for our provider sponsored organization. They will have a proven track record working within a health plan environment, with a deep understanding of clinical operations, healthcare utilization, and strategies for controlling healthcare costs while maintaining high-quality care. This key role within our Clinical Operations team is pivotal in optimizing the efficiency and effectiveness of our health plan’s utilization management programs, ensuring that medical services are delivered in a cost-effective manner while meeting the clinical needs of our members. KEY RESPONSIBILITIES: <ul> <li>Utilization Management: Lead and oversee the health plan's utilization management policies, ensuring that care is appropriately managed across all settings (inpatient, outpatient, ancillary services, etc.). Establish and enforce medical necessity criteria, review processes, and decision-making protocols. Collaborate with providers to enhance care coordination and cost efficiency through peer-to-peer reviews and secondary reviews.</li> <li>Cost Control Strategy: Develop and implement cost-effective strategies for managing the utilization of healthcare services. Utilize data-driven approaches to identify trends and opportunities to improve care delivery while reducing unnecessary costs. Collaborate with other departments to integrate cost containment initiatives across the plan.</li> <li>Clinical Leadership: Provide clinical oversight and direction for the medical management team. Serve as a subject matter expert on clinical best practices, evidence-based guidelines, and cost-effective care delivery. Management of and/or participation in internal company committees as requested.</li> <li>Appeals and Grievances: If not involved with the initial denial determination, renders an appeal determination on medical, behavioral or drug utilization management cases under review.</li> <li>Collaboration and Communication: Work closely with cross-functional teams including the network management, claims, quality improvement, and pharmacy departments to design, implement, and monitor health plan initiatives.</li> <li>Policy and Compliance: Ensure compliance with all relevant federal and state regulations, accreditation standards, and health plan policies. Stay current with industry trends, regulatory changes, and emerging healthcare technologies related to utilization management and cost control.</li> <li>Performance Metrics and Reporting: Develop and track performance metrics related to utilization, cost control, and quality outcomes. Provide regular reports to senior leadership, identifying opportunities for improvement and recommending actionable steps.</li> <li>Member and Provider Education: Educate and support providers on evidence-based guidelines and efficient care delivery practices. Engage with members to promote care management and prevention programs that align with cost-effective health outcomes.</li> <li>Innovation and Continuous Improvement: Promote a culture of continuous improvement within the medical management team. Lead efforts to enhance the efficiency of clinical workflows, reduce administrative burden, and introduce innovative solutions to optimize both clinical care and cost-effectiveness.</li> <li>Other Projects and Responsibilities: Perform other special projects and duties as assigned by the executive staff of CommunityCare Managed Healthcare Plans.</li> </ul> QUALIFICATIONS: <ul> <li>Strong analytical and data-driven decision-making skills, with experience using claims data, cost analysis, and reporting tools.</li> <li>Excellent communication, leadership, and interpersonal skills.</li> <li>Knowledge of regulatory and compliance standards within the managed care industry preferred.</li> </ul> EDUCATION/EXPERIENCE: <ul> <li>MD or DO, maintain board-certification in an ABMS recognized specialty.</li> <li>Current and active unrestricted license to practice medicine in the State of Oklahoma.</li> <li>Minimum 5 years direct patient care and clinical experience in their specialty.</li> <li>Previous experience as a Medical Director with a health plan, managed care, or health insurance organization.</li> <li>Proven expertise in utilization management, medical necessity reviews, and cost containment strategies.</li> <li>In-depth knowledge of healthcare delivery systems, including inpatient, outpatient, and ancillary care.</li> <li>Experience with clinical guidelines, evidence-based practices, and care management programs.</li> <li>Experience with health plan accreditation processes (NCQA, URAC, etc.) preferred.</li> <li>Familiarity with healthcare technology platforms, such as electronic health records (EHR) and utilization management software preferred.</li> </ul> CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin <h2 id="otherDetailsHeader">Other details</h2> <ul> <li> Job Family Commercial </li> <li> Pay Type Salary </li> </ul> <a href="#"> Apply Now </a>

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