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At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.Join HCSC and be part of a purpose-driven company that will invest in your professional development.<h1>Job Summary</h1>This position is responsible for assigned aspects of edical policies and programs. Performs medical reviews and interacts with the provider communities for assigned areas.JOB REQUIREMENTS:. * Physician (M.D. or D.O) with a current and unrestricted physician license in a the state of Oklahoma. * Maintain Board Certification by a specialty board approved by the American Board of Medical Specialties, National Board of Physicians and Surgeons, or the Advisory Board of Osteopathic Specialists * 5 years of clinical experience * Analytical and communication skills * Strategic thinking skills * Proficiency in computer skills (including software applications such as Microsoft Office Product and Lotus Notes) needed for electronic documentation of case reviews PREFERRED REQUIREMENTS: * 3 years Managed Care experienceThis is a Telecommute (Remote) role: Must reside withing 250 miles of the office or anywhere within the posted state.#LI-MG1Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!Pay Transparency Statement:At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting <a href="https://careers.hcsc.com/totalrewards" target="_blank">https://careers.hcsc.com/totalrewards</a>.The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.<h2>HCSC Employment Statement:</h2>We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.<h1>Base Pay Range</h1>$187,700.00 - $348,600.00

Blue Cross and Blue Shield of Oklahoma

Medical Director

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member.<ul> <li>Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care</li> <li>Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member</li> <li>Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered</li> <li>Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines</li> <li>Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings</li> <li>Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members</li> <li>Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines</li> <li>Reviews member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities</li> <li>Collaborates with care management on referral of members as appropriate</li> <li>Performs other duties as assigned</li> <li>Complies with all policies and standards</li> </ul>Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. 2+ years of acute care experience required. Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred.NYS nursing license required License/Certification:<ul> <li>LPN - Licensed Practical Nurse - State Licensure required</li> <li>RN - Registered Nurse -State Licensure required</li> </ul>Pay Range: $26.50 - $47.59 per hourCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Oklahoma Complete Health

Clinical Review Nurse - Concurrent Review

You could be the one who changes everything for our 28 million members by using technology to improve health outcomes around the world. As a diversified, national organization, Centene's technology professionals have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Designs, develops, and implements complex enterprise software solutions. Collaborates closely with technical and non-technical roles such as data modelers, architects, business analysts, data stewards, and subject matter experts (SMEs) to provide design, technical analysis, development/configuration, testing, implementation, and support expertise representing the interest of the business across the enterprise.<ul> <li>Develops or prototypes software modules at various levels of complexity, including but not limited to: service interfaces, process flows, service messages, SOA components, business logic, UI/UX, or data access logic</li> <li>Designs, develops, tests, and deploys software solutions and process flows complying with standards, guidelines, and best practices</li> <li>Identifies, assesses, and formulates architectural impacts and solutions from business requirements</li> <li>Collaborates to ensure application designs utilize appropriate patterns and standards</li> <li>Analyzes user needs and software requirements to determine feasibility of design within time and cost constraints, including the ability to estimate work needed</li> <li>Assesses functional and nonfunctional requirements and creates designs to meet both business and technical needs</li> <li>Creates conceptual and detailed technical design documents and works with the business to update, as needed</li> <li>Identifies and resolves problems, often anticipating issues before they occur or before they grow, develops and evaluates options, and implements solutions</li> <li>Utilizes and contribute to the development of application coding techniques and standards</li> <li>Collaborates with Application Solution Architects, IS Business Analysts and other technical resources on the delivery of application functionality</li> <li>Participates in tier 3 application support activities including incident management and the assessment and delivery of application upgrades and patches</li> <li>Performs other duties as assigned</li> <li>Complies with all policies and standards</li> </ul>Education/Experience: A Bachelor's degree in a quantitative or business field (e.g., statistics, mathematics, engineering, computer science). Requires 4 – 6 years of related experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. Technical Skills: <ul> <li>One or more of the following skills are desired.</li> <li>Experience with Other: evaluating and improving Code Quality /Standards</li> <li>Experience with Other: working with and directing third-party Application Developers</li> <li>Knowledge of Programming Concepts; Software Design</li> </ul> Soft Skills: <ul> <li>Intermediate - Seeks to acquire knowledge in area of specialty</li> <li>Intermediate - Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions</li> <li>Intermediate - Ability to work independently</li> <li>Intermediate - Demonstrated analytical skills</li> <li>Intermediate - Demonstrated project management skills</li> <li>Intermediate - Demonstrates a high level of accuracy, even under pressure</li> <li>Intermediate - Demonstrates excellent judgment and decision making skills</li> </ul> License/Certification: <ul><li>Scaled Agile Framework (SAFe) preferred</li></ul>Pay Range: $85,300.00 - $158,100.00 per yearCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Senior Application Development Engineer

<a href="#"> </a> <a href="#">About Us</a> <a href="#">Current Employee Job Search</a> <a href="#">Go to Hillcrest HealthCare System Careers</a> <ul> <li> <a href="#">Home</a> <a href="#">Home</a> </li> <li> <a href="#">Locations</a> <a href="#">Locations</a> </li> <li> <a href="#">Nursing Careers</a> <a href="#">Nursing Careers</a> </li> <li> <a href="#">Provider Careers</a> <a href="#">Provider Careers</a> </li> <li> <a href="#">Corporate Careers</a> <a href="#">Corporate Careers</a> </li> <li> <a href="#">Executive Careers</a> <a href="#">Executive Careers</a> </li> <li> <a href="#">Join Talent Community</a> <a href="#">Join Talent Community</a> </li> </ul> <ul> <li> <a href="#">Home</a> </li> <li> <a href="#">Locations</a> </li> <li> <a href="#">Nursing Careers</a> </li> <li> <a href="#">Provider Careers</a> </li> <li> <a href="#">Corporate Careers</a> </li> <li> <a href="#">Executive Careers</a> </li> <li> <a href="#">Join Talent Community</a> </li> <li> <ul> <li><a href="#">Careers Home</a></li> <li><a href="#">Search Jobs</a></li> </ul> </li> </ul> Candidates residing in the following states, CA, CO, CT, HI, IL, MA, MD, ME, MI, MN, NH, NV, NY, OR, RI, VT, WA, Washington DC and WV, must be willing to relocate if they are hired in a remote role. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. FOLLOW US <a href="https://www.linkedin.com/company/hillcrest-healthcare-system" target="_blank"> </a> <a href="https://www.youtube.com/user/HillcrestMedicalCtr" target="_blank"> </a> <a href="https://www.facebook.com/UticaPark" target="_blank"> </a> <h4>ARDENT HEALTH SERVICES</h4> Ardent Health Services invests in quality health care. In people, technology, facilities and communities, Ardent makes considerable investments – producing high quality care and extraordinary results. <h4>CONTACT US</h4> 340 Seven Springs Way Suite 100, Brentwood, TN 37027 (615) 296-3000 We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Copyright © Ardent Health Services. All rights reserved. <a href="#">Providerrecruitment@ardenthealth.com</a> <a href="#">Providerrecruitment@ardenthealth.com</a> <a href="#">Providerrecruitment@ardenthealth.com</a> <a href="#">Providerrecruitment@ardenthealth.com</a> <a href="#">Providerrecruitment@ardenthealth.com</a> <a href="#">Providerrecruitment@ardenthealth.com</a>

Utica Park Clinic

Shape the Future of Cardiology: Full-Time ACNP at Oklahoma Heart Institute!

Jenks Public Schools

Bus Assistant

Site Principal

Head Band Director

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. ***Remote role. Preferred candidate has strong background in Utilization Management/Claims Review and/or Appeals.***Position Purpose: Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards.<ul> <li>Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal</li> <li>Ensures timely review, processing, and response to appeal in accordance with State, Federal and NCQA standards</li> <li>Communicates with members, providers, facilities, and other departments regarding appeals requests</li> <li>Generates appropriate appeals resolution communication and reporting for the member and provider in accordance with company policies, State, Federal and NCQA standards</li> <li>Works with leadership to increase the consistency, efficiency, and appropriateness of responses of all appeals requests</li> <li>Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best practices</li> <li>Performs other duties as assigned</li> <li>Complies with all policies and standards</li> </ul>Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification:<ul> <li>LPN - Licensed Practical Nurse - State Licensure required or</li> <li>LVN - Licensed Vocational Nurse required or</li> <li>RN - Registered Nurse - State Licensure and/or Compact State Licensure required or</li> <li>LCSW- License Clinical Social Worker required or</li> <li>LMHC-Licensed Mental Health Counselor required or</li> <li>LPC-Licensed Professional Counselor required or</li> <li>Licensed Marital and Family Therapist (LMFT) required or</li> <li>Licensed Psychologist required</li> </ul>Pay Range: $26.50 - $47.59 per hourCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Clinical Review Clinician - Appeals

<h3>Details </h3><ul> <li> Department: Observation</li> <li> Schedule: Full time, Night Shift, 36 hours a week</li> <li> Hospital: Ascension St. John</li> <li> Location: Tulsa, OK</li> </ul>Relocation assistance available!<h3>Benefits </h3>Paid time off (PTO) Various health insurance options &amp; wellness plans Retirement benefits including employer match plans Long-term &amp; short-term disability Employee assistance programs (EAP) Parental leave &amp; adoption assistance Tuition reimbursement Ways to give back to your community*Please note, benefits and benefits eligibility can vary by position, exclusions may apply for some roles (for example: Travel, PRN, Short-Term Option, etc.). Actual compensation offer will vary based upon role, education, experience, location, and qualifications. Connect with your Talent Advisor for additional specifics.<h3>Responsibilities </h3>Coordinate unit staffing and provide leadership while ensuring implementation of clinical objectives and quality patient care in assigned area.<ul> <li>Assign, direct, educate and monitor nursing and support staff during assigned shift.</li> <li>Assess daily patient care needs and develop and distribute patient care assignments, ensuring that population appropriate patient care is given.</li> <li>Evaluate the effectiveness of patient care and identify any issues that affect desired patient outcomes.</li> <li>Respond to complaints about patient care and manage through established channels.</li> <li>May provide input for hiring, training, directing, development and evaluating of staff.</li> </ul><h3>Requirements </h3>Licensure / Certification / Registration:<ul> <li>BLS Provider obtained within 1 Month (30 days) of hire date or job transfer date required. American Heart Association or American Red Cross accepted.</li> <li>Registered Nurse credentialed from the Oklahoma Board of Nursing required.</li> <li>Licensed Registered Nurse obtained prior to hire date or job transfer date required.</li> </ul>Education:<ul><li>Required professional licensure/certification AND 1 year of cumulative job specific experience required.</li></ul><h3>Additional Preferences </h3>No additional preferences.<h3>Why Join Our Team </h3>Ascension St. John has been serving Northeast Oklahoma with compassionate, personalized care since 1926. Join more than 7,000 associates and find a rewarding healthcare career at one of our 6 hospitals and numerous other sites of care. When you join our care teams, you join a team dedicated to providing spiritually centered, holistic care which sustains and improves the health of the communities we serve.Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.<h3>Equal Employment Opportunity Employer </h3>Ascension will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.For further information, view the <a href="https://www.eeoc.gov/sites/default/files/2022-10/22-088_EEOC_KnowYourRights_10_20.pdf" target="_blank">EEO Know Your Rights (English)</a> poster or <a href="https://www.eeoc.gov/sites/default/files/2022-10/22-088_EEOC_KnowYourRightsSp_10_20.pdf" target="_blank">EEO Know Your Rights (Spanish)</a> poster.As a military friendly organization, Ascension promotes career flexibility and offers many benefits to help support the well-being of our military families, spouses, veterans and reservists. Our associates are empowered to apply their military experience and unique perspective to their civilian career with Ascension.<a href="https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf" target="_blank">Pay Non-Discrimination Notice</a>Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.<h3>E-Verify Statement </h3>This employer participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information. <a href="https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf" target="_blank">E-Verify</a>

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