Qureos Mentor

CommunityCare

JOB SUMMARY: 
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: 
<ul>
<li>Collaborate across all lines of business to promote annual business goals and strategic plans.</li>
<li>Establish and maintain assigned book of business.</li>
<li>Product and market knowledge pertaining to our three lines of business.</li>
<li>Expand and establish positive business relationships with strategic broker partners, contracted providers, health-systems, and community organizations and its leaders.</li>
<li>Provides support for brokers, agents, agencies and FMO partners.</li>
<li>Schedule and attend agent market facing events.</li>
<li>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.</li>
<li>Participate in preparing and conducting special marketing events and community engagement.</li>
<li>Assist in maintaining internal databases, CRM, and other monthly monitoring activities as company procedure.</li>
<li>Performs other duties as assigned.</li>
</ul>
QUALIFICATIONS: 
<ul>
<li>Excellent oral and written communication skills.</li>
<li>Self-motivated and able to work with minimal supervision.</li>
<li>High level of customer service skills.</li>
<li>Innovative and driven by improvement.</li>
<li>Must have a current driver’s license and vehicle insurance verification.</li>
<li>Successful completion of Health Care Sanctions background check.</li>
<li>Successful completion of Motor Vehicle Record Check.</li>
<li>Ability to converse and write fluently in English.</li>
</ul>
EDUCATION/EXPERIENCE: 
<ul>
<li>High School equivalency and 4 years of work related experience in insurance, healthcare or related field.</li>
<li>State of Oklahoma Life and Health Insurance License or ability to obtain license within 45 days of hire date.</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

Medicare & Individual Marketing - Broker Relations & Market Development Representative 176-1020

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

Vendor Services - Contract Administrator 147-2000

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: 
<ul>
<li>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.</li>
<li>Works collaboratively with other departments in providing or seeking claims review and/or clinical guidance. Participates in company committees or work groups as assigned.</li>
<li>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.</li>
<li>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.</li>
<li>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.</li>
<li>Monitors the medical claim review tracking database for quality control. Compiles and analyzes data and prepares routine compliance reports.</li>
<li>Performs other duties as required.</li>
</ul>
QUALIFICATIONS: 
<ul>
<li>Excellent analytical and problem-solving skills</li>
<li>Able to work independently as well as supervise others to meet stringent deadlines</li>
<li>Strong attention to detail. Highly organized and capable of managing multiple projects.</li>
<li>Proficient in Microsoft applications.</li>
<li>Possess strong oral and written communication.</li>
<li>Ability to work as a team in a high paced environment.</li>
<li>Successful completion of Health Care Sanctions background check.</li>
</ul>
EDUCATION/EXPERIENCE
 <ul>
<li>Current active, unrestrictive license to practice as a Registered Nurse (RN) in the State of Oklahoma.</li>
<li>BSN preferred</li>
<li>Minimum of five years combined employment in facility/provider health care settings or managed care organization.</li>
<li>Two years supervisory experience preferred.</li>
<li>Prefer strong clinical related background and case review experience focused in healthcare fraud, waste and abuse.</li>
<li>Require experience or familiarity with state and federal regulations governing healthcare coding, billing and claims processing. Recognized healthcare coding certification (CPC, AHIMA, etc.) 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

Medical Management - Supervisor Medical Review 145-4005

JOB SUMMARY: 
The HR Operations & Employee Relations Administrator addresses employee concerns, promoting engagement and ensuring a fair and consistent application of company policies. Serves as an advisor to managers and employees for employee relations, investigations, etc. Supports management with the creation of SMART goals and performance and succession planning.
 
KEY RESPONSIBILITIES: 
<ul>
<li>Assist employees with engagement initiatives, surveys, and feedback collection.</li>
<li>Serve as a point of contact for employee inquiries and workplace concerns.</li>
<li>Promote positive employee relations through conflict resolution and mediation.</li>
<li>Advising managers on performance and disciplinary issues.</li>
<li>Ensure HR policies, procedures, and documentation are up-to-date and compliant.</li>
<li>Drive continuous improvement in HR operations through process automation, reporting, and compliance audits.</li>
<li>Help implement performance appraisal processes and development feedback tools.</li>
<li>Serve as a trusted advisor to managers and employees on workplace issues, policy interpretation, and conflict resolution.</li>
<li>Conduct internal investigations in response to complaints or concerns, ensuring thorough documentation and timely resolution.</li>
<li>Support performance management processes, including coaching, corrective actions, and termination procedures.</li>
<li>Develop employee succession planning, career planning with strategic thinking using performance and potential assessments, i.e. “5 Box Theory”.</li>
<li>Performs other duties as assigned.</li>
</ul>
QUALIFICATIONS: 
<ul>
<li>Knowledge of talent management tools used in performance and potential assessments.</li>
<li>Excellent oral and written communications skills.</li>
<li>Working knowledge of employment laws (FMLA, ADA, EEO, FLSA, etc.).</li>
<li>Exceptional interpersonal, strong conflict resolution, and organizational skills.</li>
<li>High level of integrity and confidentiality in handling sensitive information.</li>
<li>Successful completion of Health Care Sanctions background check.</li>
<li>Strong project management skills and ability to lead cross-functional initiatives.</li>
<li>Excellent attention to detail.</li>
<li>Ability to work collaboratively and with a supportive attitude.</li>
<li>Ability to work independently with minimal supervision.</li>
<li>Ability to assess tasks based on urgency and importance.</li>
</ul>
EDUCATION/EXPERIENCE: 
<ul>
<li>Bachelor’s degree in human resources, Business Administration, or a related field; HR certification (e.g., SHRM-CP/SCP or PHR/SPHR) preferred.</li>
<li>5+ years of experience in HR, with a strong focus on operations and employee relations.</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

Human Resources - HR Operations & Employee Relations Administrator 155-2012

JOB SUMMARY: 
The Senior Data Engineer is responsible for expanding and optimizing our data and data pipeline architecture, as well as optimizing data flow and collection across organizational teams. The Sr. 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. This position is also expected to provide updates and guidance on data engineering related projects to the Data Governance Committee.
 
KEY RESPONSIBILITIES: 
<ul>
<li>Create and maintain optimal data pipeline architectureto support our next generation of products and data initiatives.</li>
<li>Assemble large, complex data sets that meet functional business requirements.</li>
<li>Identify, design, and implement internal process improvements: automating manual processes, optimizing data delivery, re-designing infrastructure for greater scalability.</li>
<li>Build the infrastructure required for optimal extraction, transformation, and loading of data from a wide variety of data sources using Oracle, SQL and Azure.</li>
<li>Build analytics tools that utilize the data pipeline to provide actionable insights into customer acquisition, operational efficiency and other key business performance metrics.</li>
<li>Provide guidance to other Data Engineers on the team for the purposes of training</li>
<li>Performs other duties as required.</li>
</ul>
QUALIFICATIONS: 
<ul>
<li>Build processes supporting data transformation, data structures, metadata, dependency and workload management.</li>
<li>A successful history of manipulating, processing and extracting value from large disconnected datasets.</li>
<li>Strong project management and organizational skills.</li>
<li>Ability to work both independently and as a team on multiple projects simultaneously.</li>
<li>Experience building and optimizing ‘big data’ data pipelines, architectures and data sets.</li>
</ul>
EDUCATION/EXPERIENCE: 
<ul>
<li>College degree or equivalent experience required.</li>
<li>Minimum six years of related experience developing data pipelines.</li>
<li>Minimum six years supporting data warehouses.</li>
<li>Demonstrated experience preparing analytical reports and developing data models.</li>
<li>Project management skills required.</li>
<li>Willingness to work in a high-tech, continually evolving, innovative environment.</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

Enterprise Applications - Senior Data Engineer 134-2001

JOB SUMMARY: 
Supports the organization in advancing its brand awareness and community engagement through the management and expansion of digital media. This individual will plan and execute digital campaigns, manage the organization’s social media, monitor performance metrics and contribute to outreach initiatives that connect the organization with its members and the broader community. The ideal candidate will possess strong communication skills, creativity, a working knowledge of current social media trends and tools, understanding of digital advertising, and video production skills. This candidate will also proactively collaborate with internal stakeholders to align them with community engagement opportunities, such as local chambers of commerce events.
 
KEY RESPONSIBILITIES: 
<ul>
<li>Manage day-to-day social media content for the organization’s social media platforms</li>
<li>Create, schedule and publish engaging content that aligns with our mission and goals</li>
<li>Design and implement social media campaigns to raise brand awareness, drive engagement, and support enrollment or health initiatives</li>
<li>Manage and/or coordinate the organization’s digital advertising campaigns</li>
<li>Monitor performance and engagement metrics; prepare regular reports and insights</li>
<li>Stay current with social media trends and suggest new platforms or strategies</li>
<li>Coordinate with internal teams to source stories, photos and other shareable content</li>
<li>Assist with community events, outreach campaigns and other engagement efforts</li>
<li>Respond to comments and messages in a timely and professional manner</li>
<li>Ensure all content reflects the organization’s voice and comply with applicable guidelines (e.g., HIPAA, branding)</li>
</ul>
QUALIFICATIONS: 
<ul>
<li>Successful completion of Health Care Sanctions background check</li>
<li>Profound attention to detail</li>
<li>Experience managing professional social media accounts</li>
<li>Strong understanding of major social media platforms (Facebook, Instagram, X, LinkedIn, etc.) and analytics tools</li>
<li>Excellent writing, verbal, and visual communication skills</li>
<li>Experience with design tools (e.g., Adobe Creative Suite, Canva or similar)</li>
<li>Experience with Meta Ads Manager, Google Ads, and LinkedIn Campaign Manager</li>
<li>Video production skills preferred</li>
<li>Highly organized and self-directed; able to manage multiple projects at once and meet deadlines</li>
<li>Experience with community engagement or event support is a plus</li>
<li>Ability to work independently with minimal supervision and proven ability to manage multiple tasks and regular deadlines</li>
<li>Ability to take initiative and seek innovative ideas</li>
<li>General knowledge of health insurance rules, regulations, and requirements preferred</li>
</ul>
EDUCATION/EXPERIENCE: 
<ul>
<li>Bachelor’s degree in public relations, marketing, communications, business administration, health care administration or a related field or relevant experience 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

Corporate Communications - Digital Media Specialist 118-2000

Join CommunityCare and explore 6   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.