Community Care jobs in Tulsa, OK - 38 jobs

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 customers. You will be responsible for providing ongoing coaching to inspire our Customer Service Representatives to deliver exceptional customer service as well as coaching to develop CSRs in their current role or to take on additional responsibilities. You will play a collaborative role in growing and implementing company standards and processes. You will communicate within the department and interdepartmentally and should be analytical, supportive and prepared to act as a resource. You will be responsible for meeting and maintaining performance benchmarks, meeting operational compliance requirements required by CMS regulations, company and departmental policies and managing critical processes. To ensure success you need to employ prudence and tact in interacting with others and be focused on customer and staff retention. Be a driver of change and passionate about helping employees adapt to organizational change. KEY RESPONSIBILITIES: Perform to a high level of accuracy through effective time management, being meticulous and organized. Manage and assess customer service staff activities and provide CSRs with regular performance-related feedback and coaching. Strategizing and monitoring of daily activities of customer service operation and telephone performance standards. Make staff adjustments as required. Hiring, training and preparing call center representatives to respond to customer questions and complaints and troubleshoot problems to successful resolution for our members. Ensure CSRs understand and comply with all contact center objectives, performance standards and policies. Monitor and evaluate CSR performance, provide learning and coaching opportunities and take appropriate corrective action when necessary. Analyze data and collaborate with other supervisors and members of management to maintain contact center results that maximize customer satisfaction. Identify operational issues and seek improvements. Lead and implement change initiatives related to business processes and improvements. Drive adoption and proficiency changes within the organization. Coaches and motivates assigned staff to achieve highest quality and quantity of work and to exceed customer expectations. Responds and resolves member/provider issues/complaints elevated to a supervisory level. Actively participates on company and departmental committees as assigned. Identifies and communicates any new processes or activities that directly impact employees or operations of department. Communicates regularly to employees any benefit, network, or process changes that have a direct impact on inquiry responses. Maintains regularly scheduled meetings to inform and instruct staff of any changes in process or compliance issues. Assist in the development or review of departmental policies and procedures to ensure operational excellence. Other duties as assigned. QUALIFICATIONS: Thorough knowledge of CMS regulations for MAOs as related to customer service functions. Proficiency with technology, especially computers, software applications and phone systems. Excellent problem solving, leadership and customer service skills. Analytical, efficient, and thorough. Demonstrated ability to coach, train and motivate employees and evaluate their performance. Exceptional verbal and written communication skills. Ability to read, analyze and interpret complex documents including health benefit manuals. Ability to remain calm and courteous under pressure and navigate tense situations. Highly organized and attentive to detail. Successful completion of Health Care Sanctions background check. EDUCATION/EXPERIENCE: High School diploma or equivalent; Bachelor's degree preferred. Three to five years' previous customer service experience preferably in a call center or healthcare environment or equivalent educational experience. Minimum 1 year in leadership or decision-making role within customer service department.

The Enterprise Data Architect provides strategic and technical leadership for the design, governance, and evolution of the organization's enterprise data ecosystem. This role serves as the senior authority on data architecture during large-scale enterprise system implementations and defines the long-term data strategy to enable analytics, interoperability, and regulatory compliance across the health plan. The architect ensures the enterprise's data platforms are modern, scalable, secure, and aligned with business goals-enabling accurate, real-time, and trusted data to drive operational excellence, member outcomes, and organizational insight. KEY RESPONSIBILITIES: Develop and maintain the Enterprise Data Architecture Blueprint, covering data domains, integration patterns, metadata, and master data management. Establish the enterprise data strategy aligned with business and regulatory objectives-balancing modernization (e.g., cloud adoption, real-time data) with operational continuity. Partner with the Enterprise Architecture Team, PMO and Business Intelligence to ensure architectural consistency across systems (adjudication, provider, member, finance, analytics, CRM, etc.). Define the future-state architecture leveraging modern data platforms (e.g., Azure, Databricks) and emerging interoperability frameworks (FHIR, APIs, event streaming). Serve as the lead data architect for the enterprise platform implementation (e.g., migration from legacy core system to new adjudication platform). Oversee data migration and integration strategy, including mapping, quality controls, and validation between legacy and new systems. Guide data engineering teams in building pipelines, warehouses, and marts aligned to architecture standards. Direct data modeling efforts-conceptual, logical, and physical-ensuring consistency and reusability across domains. Participate in the Data Governance Committee in partnership with Compliance and Analytics leadership. Define enterprise policies for data quality, stewardship, access control, and retention, ensuring alignment with HIPAA, SOC 2, CMS, and NIST frameworks. Collaborate with the Chief Compliance Officer to ensure PHI/PII protection and privacy-by-design principles in all data workflows. Support the development of the enterprise data warehouse and self-service analytics ecosystem. Partner with business intelligence and actuarial teams to enable trusted data assets for analytics, reporting, and AI/ML use cases. Provide architectural oversight for predictive and generative AI initiatives, ensuring responsible data use and model governance. Mentor data engineers, modelers, and analysts, fostering a data-driven culture. Translate complex technical architectures into executive-level strategy presentations. Partner cross-functionally with Operations, Finance, Clinical, and IT to ensure data supports enterprise KPIs and value-based care initiatives. Performs other job related duties as assigned. QUALIFICATIONS: Proven leadership in a large-scale data modernization or enterprise system implementation. Expertise in modern data platforms (Azure), data modeling, and integration frameworks. Strong understanding of HIPAA, NIST, CMS data standards, and healthcare interoperability (FHIR, HL7). Successful completion of Health Care Sanctions background check EDUCATION/EXPERIENCE: Bachelor's degree in Computer Science, Information Systems, Data Science, or related field. 10+ years in data architecture, data engineering, or enterprise architecture roles. Preferred 5+ years in healthcare or health insurance data environments (claims, provider, member, EDI, utilization, quality).

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: Examining and adjudicating claims that have pended for review utilizing resources, tools, knowledge and decision-making in determining appropriate actions. Identify claims requiring additional resources and route to the team lead, supervisor or other departments as needed. Enter claims information using the processing software to compute payments, allowable amounts, limitations, exclusions and denials. Identify and communicate trends or problems identified during adjudication process. Contribute to the creation of a pleasant working environment with peers and other departments. Assist in investigating and solving claims that require additional research. Consistently learn and adapt to changes related to claims processing, benefits, limits and regulations. Perform other duties as assigned. QUALIFICATIONS: Self-motivated and able to work with minimal direction. Ability to read and understand claims processing manuals, medical terminology, CPT codes, and perform basic processing procedures. Ability to read and understand health benefit booklets. Demonstrated learning agility. Successful completion of Health Care Sanctions background check. Knowledge in the contracted managed care plan terms and rates. General understanding of unbundling methods, COB, and other over-billing methodologies. Must have high attention to detail. Proficient in Microsoft applications. Ability to perform basic mathematical calculations. Possess strong oral and written communication skills. EDUCATION/EXPERIENCE: High School Diploma or Equivalent required. Two years related work experience in claims processing, claims data entry or medical billing OR medical related education to meet minimum two years required.

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: 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. 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. 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. 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. 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. 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. 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. 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. 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. Other Projects and Responsibilities: Perform other special projects and duties as assigned by the executive staff of CommunityCare Managed Healthcare Plans. QUALIFICATIONS: Strong analytical and data-driven decision-making skills, with experience using claims data, cost analysis, and reporting tools. Excellent communication, leadership, and interpersonal skills. Knowledge of regulatory and compliance standards within the managed care industry preferred. Successful complete a Health Care Sanctions background check. EDUCATION/EXPERIENCE: MD or DO, maintain board-certification in an ABMS recognized specialty. Current and active unrestricted license to practice medicine in the State of Oklahoma. Minimum 5 years direct patient care and clinical experience in their specialty. Previous experience as a Medical Director with a health plan, managed care, or health insurance organization. Proven expertise in utilization management, medical necessity reviews, and cost containment strategies. In-depth knowledge of healthcare delivery systems, including inpatient, outpatient, and ancillary care. Experience with clinical guidelines, evidence-based practices, and care management programs. Experience with health plan accreditation processes (NCQA, URAC, etc.) preferred. Familiarity with healthcare technology platforms, such as electronic health records (EHR) and utilization management software preferred.

The Member Advocate I serves as a liaison between members and CommunityCare, ensuring a high-quality member experience through personalized support and problem resolution. The Member Advocate helps members navigate the healthcare system, understand their benefits, and resolve any issues or barriers to care. This role is essential in promoting member satisfaction, retention, and trust. KEY RESPONSIBILITIES: Serve as the primary point of contact for members who need support with navigating their CommunityCare health plan. Assist members in understanding their benefits, claims, provider options, prior authorizations, and other services. Identify and resolve member issues, including escalated complaints and barriers to care. Coordinate with internal departments such as Utilization Management, Claims, Provider Services, and Enrollment Services to resolve concerns. Educate members on wellness programs, preventive services, and available resources. Track and document member interactions in accordance with regulatory and CommunityCare. Ensure compliance with CMS, state, and other regulatory requirements in all member communications. Assist members with scheduling appointments at many of the events we host. Assist with inbound and outbound calls as needed to support the initiatives of the Senior Center. Performs other duties as required or assigned. QUALIFICATIONS: Excellent phone etiquette, face-to-face verbal interactions, and written communication skills. Strong customer service orientation and active listening skills. Ability to handle sensitive and confidential information with professionalism. Knowledge of health insurance terminology, benefits, and regulatory guidelines. Proficiency in Microsoft Office EDUCATION/EXPERIENCE: High school diploma or equivalent required; Associate's or Bachelor's degree preferred. 2+ years of experience in healthcare and/or customer service. Experience with health insurance plans strongly preferred.

This position works under the Marketing Department's Broker Relations and Market Development team. Employee must work collaboratively across all lines of business in achieving annual membership goals by promoting 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 marketing initiatives.Responsible for broker retention and management, assistance in servicing and training, event coordination, and problem resolution. KEY RESPONSIBILITIES: Collaborate across all lines of business to promote annual business goals and strategic plans. Establish and maintain assigned book of business. Product and market knowledge pertaining to our three lines of business. Expand and establish positive business relationships with strategic broker partners, contracted providers, health-systems, and community organizations and its leaders. Provides support for brokers, agents, agencies and FMO partners. Schedule and attend agent market facing events. Responsible to identify new opportunities with health insurance agents, brokers and consultants, and trains, educates and works with them to enhance the appeal of the company and its products being offered. Participate in preparing and conducting special marketing events and community engagement. Assist in maintaining internal databases, CRM, and other monthly monitoring activities as company procedure. Performs other duties as assigned. QUALIFICATIONS: Excellent oral and written communication skills. Self-motivated and able to work with minimal supervision. High level of customer service skills. Innovative and driven by improvement. Must have a current driver's license and vehicle insurance verification. Successful completion of Health Care Sanctions background check. Successful completion of Motor Vehicle Record Check. Ability to converse and write fluently in English. EDUCATION/EXPERIENCE: High School equivalency and 4 years of work related experience in insurance, healthcare or related field. State of Oklahoma Life and Health Insurance License or ability to obtain license within 45 days of hire date.

KEY RESPONSIBILITIES: Prepares correspondence to members, providers, and facilities. Provides follow up with providers and members as needed. Reviews service requests for completeness of information. Enters information into the database, compiles data and runs reports. Receives telephone calls, answers non-clinical questions and takes information, or refers callers to appropriate parties. Investigates and researches calls from members, physician offices, ancillary vendors, and facilities to facilitate the authorization process. Duties and responsibilities of this role are clerical in nature and are not involved in in the interpretation of clinical information or evaluations. Performs other duties as assigned. QUALIFICATIONS: Possess strong oral and written communication skills. Successful completion of Health Care Sanctions background check. Ability to reason logically and to use good judgment when interpreting materials or situations. Ability to organize time effectively and set priorities. Basic knowledge of medical terminology. Proficient in Microsoft applications. EDUCATION/EXPERIENCE: High School Diploma or equivalent. Two years related work experience in medical, insurance or doctor's office environment preferred. Successful completion of college level education in health-related field may be applied in lieu of work experience.

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 prevent errors from recurring. This position will also provide financial supporting functions to the Director of Pharmacy such as high-alert drug notifications and weekly invoice comparisons. KEY RESPONSIBILITIES: Audit and monitor company processes and business activities. Verifying all documentation and regulatory requirements are met. Meet with process owners and or departments to obtain corrective action plans and obtain resolution. Prepare reports of findings to present to stakeholders. Track status and monitor plans through implementation. Conduct follow-up audits to ensure corrective actions address the root cause and prevent errors from recurring. Track new members on high-cost drugs. Performs other duties as required. QUALIFICATIONS: Ability to perform detailed mathematical calculations and understanding of mathematical concepts and abstract reasoning. Ability to converse and write fluently in English Ability to read with understanding, to reason logically and to use good judgement when interpreting materials or situations. Ability to plan, organize, schedule and follow through on assignments. Excellent interpersonal skills and the ability to work with individuals at all levels of the organization. Successful completion of Heath Care Sanctions background check. Proficient in Microsoft applications. EDUCATION/EXPERIENCE: Bachelor's degree preferred. 1-3 years' experience in auditing. Certified Internal Auditor (CIA) or Certified in Healthcare Compliance (CHC) certification preferred. Experience in managed healthcare preferred.

The Medical Review Supervisor is responsible for overseeing activities and personnel involved in the day to day operations of CommunityCare's medical claim review program. The Supervisor guides individuals in implementing auditing and monitoring functions aimed at identifying areas of risk and/or potential fraud, waste and abuse, as it relates to provider billing practices. KEY RESPONSIBILITIES: Provides technical expertise to Medical Review (MRE) staff including analysis, problem solving, and decision making of complex claim reviews. Identifies medical necessity and /or quality issues for further evaluation. Oversees triage of pended and high dollar claims. Collaborates with external vendors on cases meeting reinsurance thresholds and specific requirements for ASO lines of business. Works collaboratively with other departments in providing or seeking claims review and/or clinical guidance. Participates in company committees or work groups as assigned. Proactively conducts routine monitoring and identifies areas of potential fraud, waste and/or abuse (FWA). Formulates recommendations based on findings. Suggests opportunities for focused reviews. Works collaboratively with the Compliance Officer and/or Special Investigations (SIU) as needed. Coordinates and/or oversees daily activities of the MRE staff. This includes planning, implementing and evaluating MRE goals. It also includes monitoring workload, staff supervision, training, coaching, auditing, teambuilding, performance evaluation and hiring/retaining staff. Provides training for new MRE staff including one-to-one sessions as required for successful staff mastery of job tasks related to claim reviews and special projects. Develops and implements operational guidelines for applicable payment policies and/or for other processes pertaining to the medical claim review function. Seeks organizational approval as indicated. Monitors the medical claim review tracking database for quality control. Compiles and analyzes data and prepares routine compliance reports. Performs other duties as required. QUALIFICATIONS: Excellent analytical and problem-solving skills Able to work independently as well as supervise others to meet stringent deadlines Strong attention to detail. Highly organized and capable of managing multiple projects. Proficient in Microsoft applications. Possess strong oral and written communication. Ability to work as a team in a high paced environment. Successful completion of Health Care Sanctions background check. EDUCATION/EXPERIENCE Current active, unrestrictive license to practice as a Registered Nurse (RN) in the State of Oklahoma. BSN preferred Minimum of five years combined employment in facility/provider health care settings or managed care organization. Two years supervisory experience preferred. Prefer strong clinical related background and case review experience focused in healthcare fraud, waste and abuse. Require experience or familiarity with state and federal regulations governing healthcare coding, billing and claims processing. Recognized healthcare coding certification (CPC, AHIMA, etc.) preferred.

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 information to complete the reconciliation. KEY RESPONSIBILITIES: Monitors accounts receivable balances by comparing payment/adjustment reports to eligibility (both CMS & CCOK) to identify discrepancies by member. Prepare discrepancy reports for each account, communicating directly with the various contact for verification. Maintaining the files for each account, both the hard copies and electronic copies. Coordinates interdepartmental personnel involved in creating billing transactions to reflect the discrepancies verified as actual terminations, enrollments or premium changes. Verifying that transactions documented to be made were made by the appropriate persons. Performs other duties as assigned. QUALIFICATIONS: Must possess strong working knowledge of accounting principles. Proficient in Microsoft applications. Ability to work on multiple projects concurrently. Strong problem solving & critical thinking skills. Possess strong oral and written communication skills. Successful completion of Health Care Sanctions background check. EDUCATION/EXPERIENCE: High school diploma or equivalent; Associate degree preferred. One to three years of previous working experience in accounting, benefits or similar function; preferably in a healthcare environment.

The Stars Medication Adherence Specialist implements, tracks and supports new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of programs for providers and members in accordance with prescribed quality standards; conducts data collection, tracking and monitoring for key performance measurement activities at the provider and member level. Provides ongoing practice support and sustains the partnership. Improves the understanding and sensitivity to the unique needs of the CommunityCare population. This role spends 100% of time on quality program activities. KEY RESPONSIBILITIES: The Stars and Medication Adherence Specialist contributes to one or more of these quality improvement functions: Makes outbound calls to members and healthcare professionals regarding patient medications, adherence, and barrier removal. Conducts chart research and analysis to identify barriers to prescription regimens Interacts with healthcare professionals of all levels involving member medications. Calls the pharmacy or provider to assist member with medication refills, medication synchronization, or 90-day supply requests. Provides feedback and/or solutions on how to improve the medication adherence member experience. Performs other duties as assigned and modified at manager's discretion. QUALIFICATIONS: Knowledge of medication adherence practices Familiarity with State and federal regulations governing healthcare Understanding of CMS 5 Star program and requirements. Medicare Advantage and /or medical practice experience preferred Proficient in Microsoft Excel Successful completion of Health Care Sanctions background check Excellent verbal and written communication skills Ability to work independently under stringent deadlines EDUCATION/EXPERIENCE: Certification as a Pharmacy Technician with a minimum 12 months of related work experience OR A minimum of 2 years of work experience in a medication dispensing/pharmacy setting or call centerrequired High School graduate or GED equivalent; College degree preferred or equivalent combination of education and work experience.

The Director Actuary will coordinate work with CCOK's external actuaries, work closely with Marketing, Finance, Underwriting and other departments to find solutions to assist the company in achieving long-term profitable growth. The Director Actuary will have deep Health Insurance experience and a particular focus in Medicare Advantage, to direct the calculation of risk, analysis of trends, and pricing for products and services provided by the health plan. KEY RESPONSIBILITIES: Works with leadership to develop an internal actuarial function for CCOK. Coordinates with Underwriting/Product team and external actuaries on Medicare Advantage and ACA rate filings Performs analysis and maintenance of Large Group pricing models Leads team responsible for Medicare Advantage and ACA Risk Adjustment Provides custom pricing review and support for prospective and existing Large Group customers Provides analyses to support network design, provider contracts and area factors. Provides trend analysis such as cost of care, medical loss ratio, and ACA plan profitability and enrollment Supports Medical Management and Pharmacy teams on ad hoc projects Monitors market dynamics and develop competitive analysis reports Provides oversight and support to IBNR, PDR, and other actuarial accrual development Other miscellaneous analytical analysis as needed. Performs other job-related duties as required. QUALIFICATIONS: Extremely proficient in Microsoft products: Excel, Access and Word. Proficient in SAS and/or other SQL based tools. Knowledge of health insurance underwriting principles. Hands on experience with the Medicare Advantage pricing and bid process. Experience with Medicare Advantage and ACA related Risk Adjustment and RADV reporting and analysis. Strong written and verbal communication skills. Ability to clearly explain complex statistics and technical details to a non-technical audience. Ability to thrive in a dynamic and fluid environment. Work independently to meet external and internal deadlines. Successful completion of Healthcare Sanctions background EDUCATION/EXPERIENCE: B.S. Mathematics, Statistics, Actuarial Science or related degree. Associate of the Society of Actuaries (ASA) required, Fellow (FSA) preferred. 8+ years' actuarial experience in health insurance.

Responsible for providing customer service support for behavioral health benefits, directing members to appropriate in network services, processing prior authorizations according to CMS and State regulations, sending out provider faxes well as member letters, and resolving behavioral health related situations that arise from calls. KEY RESPONSIBILITIES: Available and able to be telephone support from 8AM -5PM except for lunch and breaks to support behavioral health needs for all lines of business. Provides resolution for various types of phone calls including, but not limited to referral, authorization, and verifying member eligibility, line of business and network affiliations for members and providers. Determines if the call is clinical and requires transfer to a clinical staff person. Will inform callers, including members, facility personnel, physicians, or other health care professionals of the utilization requirements and procedures. Makes initial referrals that do not require evaluation or interpretation of clinical information to behavioral health services. Completes appropriate electronic certification and progress notes documentation of activities as needed. Assists with specialized job tasks which may include claims corrections and follow-up with provider/member questions regarding claims payments, generate provider faxes, generate member letters, and other administrative tasks. Work may also involve dealing with members who are disgruntled or upset. Performs other duties as required. QUALIFICATIONS: Basic punctuation and grammar skills Ability to multi-task and manage time efficiently. Proficient in Microsoft applications. Ability to work independently and apply good judgment. Ability to maintain and preserve information of highly confidential nature. Possess strong oral communication skills. Successful completion of Health Care Sanctions background check. EDUCATION/EXPERIENCE: High school diploma or equivalent. Customer service, office management, and/or healthcare experience preferred but not required.

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 across company portals and interfaces. The UI/UX Developer will also be responsible for API integration with back-end systems with a focus on security and performance. KEY RESPONSIBILITIES: Work with a team of front-end developers and creatives to build engaging user interfaces. Implement graphics standards guides and UI style guides to branding specifications. Must be able to identify issues with front-end code and rectify them to remove bugs. Deliver high performing, responsive interfaces with Angular and Bootstrap CSS. Collaboration with the C# development team and User Experience team to solve application faults. Create unit tests to ensure code is functioning as expected. QUALIFICATIONS: Proficiency in Angular or React. Excellent JavaScript skills. Strong knowledge of HTML and CSS Strong knowledge of Bootstrap CSS Framework Experience with TypeScript and Rxjs Operators Experience with RESTful APIs and respective UI Integration Fundamental knowledge of UX/UI concepts and front-end interfaces. Fundamental knowledge of SEO. Ability to write cross-browser compatible code. Strong attention to detail. Successful completion of Health Care Sanctions background check. EDUCATION/EXPERIENCE: Bachelor's degree in computer science, software engineering or a similar field or equivalent experience. At least three years of experience working as a user interface developer. Must have strong written, visual and verbal communication skills. Self-starter with the ability to learn quickly.

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 members identified with at risk or high utilization needs. Functions as an active team member of the Utilization Management Team. KEY RESPONSIBILITIES: Performs utilization review of outpatient and ancillary services as well as inpatient and post-acute services when indicated. Determines medical necessity and appropriateness of services using clinical review criteria. Accurately documents all review determinations and contacts providers and members according to established timeframes. Appropriately identifies and refers cases that do not meet established clinical criteria to the Medical Director. Appropriately identifies and refers quality issues to Medical Management leadership. Appropriately identifies potential cases for Care Management programs. Collaborates with physicians and other providers to facilitate provision of services throughout the health care continuum. Performs accurate data entry. Communicates appropriate information to other staff members as necessary/required. Participates in continuing education initiatives. Collaborates with other departments as needed. Performs other duties as assigned. QUALIFICATIONS: Knowledge of managed care and associated group benefit plans. Possess strong oral and written communication skills. Ability to reason logically and to use good judgment when interpreting materials or situations. Knowledge of community- based resources. Must have excellent organizational skills and be able to perform multiple tasks. Proficient in Microsoft applications. Excellent time management and documentation skills. Successful completion of Health Care Sanctions background check. EDUCATION/EXPERIENCE: Graduation from accredited School of Nursing. Current, active, unrestrictive license to practice as a Registered Nurse in the State of Oklahoma. Three years of acute care experience preferred. Two years of experience working with population health preferred. Previous discharge planning or case management experience preferred. Managed care experience a plus.

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, compliant, and processed in a timely manner. The Contract Administrator also maintains contract records, monitors key deadlines, and collaborates with internal stakeholders and vendors to support smooth contract execution and compliance. This position plays a vital administrative role in maintaining the integrity and efficiency of vendor and contract-related operations. KEY RESPONSIBILITIES: Assist with the preparation, review, and processing of contracts and related documentation. Monitor contract timelines, renewal dates, and deliverables to ensure ongoing compliance. Maintain organized records of contracts, amendments, and supporting documentation in accordance with company policies and regulatory requirements. Coordinate with internal departments to ensure all contract-related information is current and accurate. Assist in gathering and verifying vendor information during onboarding and renewal processes. Track and report on contract status and performance metrics as requested. Support internal teams during contract review processes by gathering data, updating templates, and managing documentation workflows. Conduct basic research on applicable laws and organizational standards to help ensure contracts meet regulatory and policy requirements. QUALIFICATIONS: Strong attention to detail and organizational skills. Familiarity with contract documents and legal terminology is preferred. Ability to manage multiple priorities and meet deadlines. Proficient in Microsoft Office applications (e.g., Word, Excel, Outlook). Effective written and verbal communication skills. Comfortable working with cross-functional teams and external vendors. Ability to learn and use contract lifecycle management (CLM) systems, if applicable. EDUCATION/EXPERIENCE: Bachelor's degree required (Business, Legal Studies, or related field). Juris Doctorate (JD) preferred. 1+ years of experience in contract administration, legal support, or vendor management preferred. Experience in services, healthcare, or insurance industries is a plus.

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 closely with engineering, architecture, and business stakeholders to define, prioritize, and refine the product backlog - with a strong emphasis on technical feasibility, scalability, and integration with existing systems. KEY RESPONSIBILITIES: Translate business objectives into actionable technical requirements and clear development roadmaps. Collaborate with Product Managers and stakeholders to ensure product goals align with company strategy and technology standards. Own and maintain the technical product backlog; define user stories, acceptance criteria, and technical enablers. Prioritize backlog items to balance new features, technical debt reduction, infrastructure improvements, and performance enhancements. Ensure backlog is visible, transparent, and understood by all team members. Work closely with engineering teams during sprint planning, refinement, and review sessions. Serve as the primary point of contact for clarifying requirements and acceptance criteria. Partner with architects and developers to validate design and implementation decisions. Understand system integrations, APIs, data models, and platform dependencies to inform design trade-offs. Collaborate on solution architecture discussions to ensure alignment with enterprise standards. Support DevOps, cloud (e.g., Azure) optimization, and automation initiatives that enhance delivery velocity and reliability. Communicate product progress, risks, and dependencies to business and technical stakeholders. Translate complex technical topics into business-relevant language and outcomes. Analyze performance metrics, incident data, and user feedback to guide iteration and improvement. Promote best practices in Agile, CI/CD, and modern software development. Performs other job related duties as assigned. QUALIFICATIONS: Bachelor's degree in Computer Science, Information Systems, Engineering, or related field (or equivalent experience). 5+ years of experience in product ownership, software engineering, or business analysis in an Agile environment. Strong understanding of modern software architecture, APIs, cloud platforms (Azure, AWS, or GCP), and integration patterns. Experience working with development tools such as Azure DevOps, Jira, or similar. Proven ability to translate complex business needs into technical specifications. Excellent communication and facilitation skills, with the ability to influence across technical and non-technical audiences. Successful completion of Health Care Sanctions background check. EDUCATION/EXPERIENCE: Experience in healthcare, financial services, or other data-intensive environments. Familiarity with .NET, SQL Server, or other enterprise-grade technologies. Certifications such as Certified Scrum Product Owner (CSPO), SAFe Product Owner/Product Manager (POPM), or equivalent.

Responsibilities include performing credentialing activities consistently for each applicant in accordance with federal and state mandates, and credentialing criteria as outlined in the CommunityCare Managed Healthcare Plans of Oklahoma Policy and Procedure Manual. KEY RESPONSIBILITIES: Responsible for initial assessment of applications and other data for accuracy and completeness and contacting applicants or other outside resources to resolve questions or to obtain missing information. Coordinates the completion of an applicant's file and review for completeness and accuracy. Responsible for entering accurate credentialing elements relevant to each applicant in the database. Responsible for monitoring and assessing reports to ensure providers are credentialed in accordance with state mandates, and policy and procedures. Responsible for provider file maintenance. Perform other duties as assigned. QUALIFICATIONS: Possess strong oral and written communication skills. Basic Medical Terminology preferred Ability to interpret and communicate information efficiently and effectively. Successful completion of Health Care Sanctions background check. Ability to handle multiple tasks and projects simultaneously and strong organizational ability. Ability to maintain a positive working environment, project a positive attitude, and be a self-starting individual and maintain a team player attitude. Ability to handle confidential information in a professional and sensitive manner. Ability to converse and write fluently in English. EDUCATION/EXPERIENCE: High school diploma or equivalent. Associates degree OR high school diploma plus two (2) years related healthcare/managed healthcare experience. Credentialing experience in a managed care organization or hospital setting preferred.

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 support our software engineers, database architects and data analysts on data initiatives and will ensure optimal data delivery architecture is consistent throughout ongoing projects. KEY RESPONSIBILITIES: Create and maintain optimal data pipeline architecture to support our next generation of products and data initiatives. Assemble large, complex data sets that meet functional business requirements. Identify, design, and implement internal process improvements: automating manual processes, optimizing data delivery, re-designing infrastructure for greater scalability. Experience in the development of SSIS, ETL and other standardized data management tools. Build analytics tools that utilize the data pipeline to provide actionable insights into customer acquisition, operational efficiency and other key business performance metrics. Performs other duties as required. QUALIFICATIONS: Build processes supporting data transformation, data structures, metadata, dependency and workload management. Strong project management and organizational skills. Ability to work independently, handle multiple tasks and projects simultaneously. Successful completion of Health Care Sanctions background check. EDUCATION/EXPERIENCE: College degree or equivalent experience required. Project management skills preferred. Willingness to work in a high-tech, continually evolving, innovative environment.