Representative Jobs

Description The Clinical Strategy & Practice Lead will oversee our behavioral health (BH) clinical program for Oklahoma's Medicaid plan enrollees. They will collaborate closely with the Health Services Director and RVP, ..

Description The Senior Grievances & Appeals Professional will be dedicated to the State of Oklahoma business managing inquiries by conducting a comprehensive analytic review of contract requirements. The Senior Grievances & ..

Job Information Humana (RN)Associate Director, Care Management - Oklahoma City, OK in Tulsa Oklahoma Description The Associate Director, Care Management leads teams of nurses and behavior health professionals responsible for care ..

Description Get your foot in the door with this Entry-Level Training Ground Inside Sales Executive position! Enjoy a fast paced dynamic environment that offers a variety of responsibilities and assignments centered ..

Description The Senior Value-Based Financial Analyst supports successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. The Senior Value-Based Programs Professional works on problems ..

Description The Manager, Utilization Management (Behavioral Health) utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management ..

Description The Financial Analytics Professional 2 manages data to support and influence decisions on day-to-day operations, strategic planning and specific business performance issues. The Financial Analytics Professional 2 work assignments are ..

Description The Large Group Medical Underwriter computes rates for both renewing and prospective moderate to complex group accounts. The Large Group Underwriter 2 work assignments are varied and frequently require interpretation ..

Description The Risk Adjustment Representative 2 (Medical Record Retrieval Rep) performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments Responsibilities Be a part of ..

Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The ..

Description The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within ..

Job ID 21000EQBAvailable Openings 1 PURPOSE AND SCOPE: The registered professional nurse (CAP RN 1) position is an entry level designation into the Clinical Advancement Program for Registered Nurses. The CAP ..

Description The Manager, Care Management leads teams of nurses and behavior health professionals responsible for care management. The Manager, Care Management works within specific guidelines and procedures; applies advanced technical knowledge ..

Description The Senior Value-Based Programs Analyst supports successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. The Senior Value-Based Programs Analyst works on problems ..

Description The Care Coach 1 assesses and evaluates member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the ..

Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The ..

Description The Inbound Contacts Representative 1 represents the company by addressing incoming telephone, digital, or written inquiries. The Inbound Contacts Representative 1 performs administrative/operational/customer support/computational tasks. Typically works within a framework ..

Description The Payment Integrity Professional 2 uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. Contributes to the investigations of fraud waste and our ..

Description The Medical Coding Auditor reviews medical records to verify coding (ICD-10 CM/PCS). The Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the appropriate ..

Description The Inside Sales Executive - Specialty 2-99 responds to inbound calls inquiring about commercial health plans, places outbound calls based on leads, and completes the sales of products and/or services. ..