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<h1>Quality Improvement - Senior Manager Quality Improvement 195-6000</h1>   Tulsa, OK, USA Req #705   Tuesday, November 12, 2024   <p><strong>JOB SUMMARY:</strong></p> <p>Responsible for managing the operational and strategic aspects of the Company's Quality Improvement department, which includes the QI Program, Star Rating Program, Accreditation, and Clinical Coding and Compliance monitoring.</p>  <p><strong>KEY RESPONSIBILITIES:</strong></p> <ul> <li>Leads and directs processes and overall quality improvement activities for all beneficiaries.</li> <li> Responsible for multiple company work domains, including but not limited to: <ul> <li>Quality Improvement activities and interventions - Coordinates and oversees the company's Quality Improvement activities and interventions, including the chronic care improvement and medication therapy management programs. Provides oversight for the companywide annual QI program description, work plan and evaluation.</li> <li>Star Rating Program - Collaborates with stakeholders to develop improvements for the plan's Medicare Star Rating. Coordinates required surveys with external vendors.</li> <li>Accreditation - Coordinates the company's accreditation efforts to maintain certification of Qualified Health Plans.</li> <li>Coding and Compliance – Assists with any compliance activities including external audits from regulators. Oversees chart audits for various coding reviews.</li> </ul> </li> <li> Provides input to strategic decisions that affect the functional area of responsibility. </li> <li>Interfaces regularly with key constituency groups and other stakeholders.</li> <li>Oversees departmental administrative functions: planning and implementing company and departmental goals and objectives; hiring, training, and management of staff; and develops/improves systems and process to accomplishing work. </li> <li>Coordinates and oversees the activities of the monthly Clinical Quality Improvement and Stars Committee meetings. Participates in other company committee activities as assigned. </li> <li>Work involves meeting tight deadlines.</li> <li>Perform other duties as assigned.</li> </ul>  <p><strong>QUALIFICATIONS</strong>:</p> <ul> <li>Ability to effectively lead and supervise others.</li> <li>Ability to reason logically and to use good judgment in interpreting regulatory materials and/or situations.</li> <li>Possess strong oral and written communication skills.</li> <li>Ability to plan, organize, schedule and affect policy and procedural changes.</li> <li>Excellent organizational skills and the ability to perform multiple tasks.</li> <li>Superior skills in data analysis and statistical reasoning.</li> <li>Ability and proven experience in translating data into actionable goals.</li> <li>Proficient in Microsoft applications.</li> <li>Active listening and problem-solving skills.</li> <li>Excellent time management and documentation skills.</li> <li>Ability to write reports, develop programs and give professional presentations when needed.</li> <li>Successful completion of Health Care Sanctions background check.</li> </ul>  <p><strong>EDUCATION/EXPERIENCE:</strong></p> <ul> <li>Bachelor's degree or equivalent experience.</li> <li>Certified Professional in Healthcare Quality (CPHQ) (Preferred).</li> <li>Previous Quality Improvement and Utilization Management experience.</li> <li>Current, active, unrestrictive license to practice as Registered Nurse (RN) or Licensed Practical Nurse (LPN) in the State of Oklahoma.</li> <li>At least five years of experience in managed care, health insurance and/or health care.</li> <li>Previous supervisory or managerial experience required.</li> <li>Knowledge and awareness of Community resources.</li> </ul>        <p>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 </p>          <h2 id="otherDetailsHeader">Other details</h2> <ul> <li> Job Family Commercial </li> <li> Pay Type Salary </li> </ul>    <a href="#"> Apply Now </a>

CommunityCare

Quality Improvement - Senior Manager Quality Improvement 195-6000

Provider Services - Supervisor Credentialing 115-4004

Customer Service - Customer Service Team Lead 105-1027

Quality Improvement - Member Engagement Specialist 195-1017

Internal Audit - Supervisor Internal Audit 122-2009

Information Technology - Software Engineer 130-2048

Provider Services - Support Specialist 115-1020 (part time)

<h1>Provider Services - Provider Services Representative 115-1005</h1>   Tulsa, OK, USA Req #578   Sunday, October 20, 2024   <p><strong>JOB SUMMARY:</strong></p> <p>Primarily responsible for contracting, orientation and ongoing education of physicians, physician office staffs, hospitals and other providers regarding the policies and procedures of CommunityCare Managed HealthCare Plans. Serves as the liaison between the provider community and the health plan.</p>  <p><strong>KEY RESPONSIBILITIES:</strong></p> <ul> <li>Conducts educational and credentialing PCP and appropriate SCP office site visits according to established standards. Provides ongoing education, develops agendas, organizes informational material, facilitates workshops and participates in meetings for assigned networks. Prepares regular correspondence and special mailings to assigned providers. </li> <li>Researches and responds to issues and inquiries concerning benefits, claims, reimbursement and member issues and recommends appropriate actions to the requesting party. Assist internal departments by contacting provider offices regarding customer service/operational issues/complaints &amp; grievance resolutions and documents appropriately. </li> <li>Coordinate internal process and procedure among departments to ensure network contract / operational procedures are appropriately reflected in our systems/processes. Participate in departmental processes established to ensure accurate and timely contracting, credentialing, loading and education of providers.</li> <li>Assist contracting in all phases of the Contracting process established by CommunityCare Managed Healthcare Plans of Oklahoma. Process may include communication with provider during negotiation through completion of executed document implementation of contract, and on-going contract deliverables. Participate in the development of networks and key geographical areas as needed.</li> <li>Participates in special projects and assignments as directed, including the development of new/improved operating procedures.</li> <li>Job may contain dimensions that could affect performance of responsibility, which may involve dealing with members who are sensitive and/or emotional.</li> <li>Perform other duties as assigned.</li> </ul>  <p><strong>QUALIFICATIONS</strong>:</p> <ul> <li>Possess strong oral and written communication skills.</li> <li>Ability to monitor and assess rapidly changing information.</li> <li>Ability to think quickly and respond tactfully to sometimes difficult issues in dealing with providers.</li> <li>Successful completion of Health Care Sanctions background check.</li> <li>Proficient in Microsoft applications</li> <li>Must have a current driver’s license and insurance verification and reliable transportation.</li> </ul>  <p><strong>EDUCATION/EXPERIENCE: </strong></p> <ul> <li>Bachelor's degree required OR each year of work experience in a healthcare industry can be substituted for each year of college not completed.</li> <li>Two to three years of industry related experience in managed care, insurance, physician environment or related area.</li> <li>Customer Service and sales related experience preferred.</li> </ul>       <p>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 </p>          <h2 id="otherDetailsHeader">Other details</h2> <ul> <li> Job Family Commercial </li> <li> Pay Type Hourly </li> </ul>    <a href="#"> Apply Now </a>

Provider Services - Provider Services Representative 115-1005

<h1>Information Technology - Software Engineer 130-2058</h1>   Tulsa, OK, USA Req #658   Sunday, October 20, 2024   <strong>JOB SUMMARY: </strong> The Software Engineer will build out the next generation of our platform. As a Software Engineer, you are expected to work independently, and within teams, leading the development of software features. You will be involved with the early stages of mentoring other team members and helping with identifying process improvements for the team.<br><br>  <strong>KEY RESPONSIBILITIES: </strong> •Implements features of the application and is proficient in one or more of the feature or components.  •Leads independently and completes all assigned tasks correctly and efficiently.  •Works with Advanced software engineers on technical designs.  •Ensures code functions according to specifications and their work is completed within the allotted time frame and with high quality.  •Provides direction to other team members by being available to answer questions and perform code reviews.  •Shows direction in improving coding standards and product lines by suggesting new ideas and methods to incorporate into our existing procedures.  •Requires the ability to work well with others in and out of the scrum team.  •Ensures goals of team are being met by reporting any issues that hinder productivity or stability of product.  •Other duties as assigned. <br><br>  <strong>QUALIFICATIONS: </strong> •Experience with Microsoft SQL.  •Experience with .NET C# Object Oriented Programming.  •Fluency in JavaScript frameworks such as Angular.  •Experience designing APIs is a bonus.  •High Availability techniques in a database or applicable software environment.  •Excellent verbal and written communication skills; ability to work within strict deadlines. <br><br>  <strong>EDUCATION/EXPERIENCE: </strong> •Bachelor’s degree in computer science or equivalent experience.  •Minimum of four years’ experience required.        <p>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 </p>          <h2 id="otherDetailsHeader">Other details</h2> <ul> <li> Job Family Commercial </li> <li> Pay Type Salary </li> </ul>    <a href="#"> Apply Now </a>

Information Technology - Software Engineer 130-2058

<h1>Information Technology - Software Engineer 130-2057</h1>   Tulsa, OK, USA Req #656   Sunday, October 20, 2024   <strong>JOB SUMMARY: </strong> The Software Engineer will build out the next generation of our platform. As a Software Engineer, you are expected to work independently, and within teams, leading the development of software features. You will be involved with the early stages of mentoring other team members and helping with identifying process improvements for the team.<br><br>  <strong>KEY RESPONSIBILITIES: </strong> •Implements features of the application and is proficient in one or more of the feature or components.  •Leads independently and completes all assigned tasks correctly and efficiently.  •Works with Advanced software engineers on technical designs.  •Ensures code functions according to specifications and their work is completed within the allotted time frame and with high quality.  •Provides direction to other team members by being available to answer questions and perform code reviews.  •Shows direction in improving coding standards and product lines by suggesting new ideas and methods to incorporate into our existing procedures.  •Requires the ability to work well with others in and out of the scrum team.  •Ensures goals of team are being met by reporting any issues that hinder productivity or stability of product.  •Other duties as assigned. <br><br>  <strong>QUALIFICATIONS: </strong> •Experience with Microsoft SQL.  •Experience with .NET C# Object Oriented Programming.  •Fluency in JavaScript frameworks such as Angular.  •Experience designing APIs is a bonus.  •High Availability techniques in a database or applicable software environment.  •Excellent verbal and written communication skills; ability to work within strict deadlines. <br><br>  <strong>EDUCATION/EXPERIENCE: </strong> •Bachelor’s degree in computer science or equivalent experience.  •Minimum of four years’ experience required.        <p>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 </p>          <h2 id="otherDetailsHeader">Other details</h2> <ul> <li> Job Family Commercial </li> <li> Pay Type Salary </li> </ul>    <a href="#"> Apply Now </a>

15 CommunityCare Jobs